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Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis.
- Source :
-
The Laryngoscope [Laryngoscope] 2016 Jun; Vol. 126 (6), pp. 1390-6. Date of Electronic Publication: 2015 Nov 04. - Publication Year :
- 2016
-
Abstract
- Objectives/hypothesis: Idiopathic subglottic stenosis (iSGS) is a rare and potentially life-threatening disease marked by recurrent and progressive airway obstruction frequently requiring repeated surgery to stabilize the airway. Unknown etiology and low disease prevalence have limited the ability to characterize the natural history of iSGS and resulted in variability in surgical management. It is uncertain how this variation relates to clinical outcomes.<br />Study Design: Medical record abstraction.<br />Methods: Utilizing an international, multi-institutional collaborative, we collected retrospective data on patient characteristics, treatment, and clinical outcomes. We investigated variation between and within open and endoscopic treatment approaches and assessed therapeutic outcomes; specifically, disease recurrence and need for tracheostomy at last follow-up.<br />Results: Strikingly, 479 iSGS patients across 10 participating centers were nearly exclusively female (98%, 95% confidence interval [CI], 96.1-99.6), Caucasian (95%, 95% CI, 92.2-98.8), and otherwise healthy (mean age-adjusted Charlson Comorbidity Index 1.5; 95% CI, 1.44-1.69). The patients presented at a mean age of 50 years (95% CI, 48.8-51.1). A total of 80.2% were managed endoscopically, whereas 19.8% underwent open reconstruction. Endoscopic surgery had a significantly higher rate of disease recurrence than the open approach (chi(2) = 4.09, P = 0.043). Tracheostomy was avoided in 97% of patients irrespective of surgical approach (95% CI, 94.5-99.8). Interestingly, there were outliers in rates of disease recurrence between centers using similar treatment approaches.<br />Conclusion: Idiopathic subglottic stenosis patients are surprisingly homogeneous. The heterogeneity of treatment approaches and the observed outliers in disease recurrence rates between centers raises the potential for improved clinical outcomes through a detailed understanding of the processes of care.<br />Level of Evidence: 4. Laryngoscope, 126:1390-1396, 2016.<br /> (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)
- Subjects :
- Airway Obstruction etiology
Female
Follow-Up Studies
Humans
Laryngoscopy methods
Laryngostenosis complications
Laryngostenosis pathology
Larynx pathology
Male
Middle Aged
Recurrence
Retrospective Studies
Treatment Outcome
Airway Obstruction surgery
Laryngoscopy statistics & numerical data
Laryngostenosis surgery
Larynx surgery
Tracheostomy statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1531-4995
- Volume :
- 126
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Laryngoscope
- Publication Type :
- Academic Journal
- Accession number :
- 26536285
- Full Text :
- https://doi.org/10.1002/lary.25708