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Menna C, Fiorelli S, Marinucci BT, Massullo D, D'Andrilli A, Ciccone AM, Andreetti C, Maurizi G, Vanni C, Siciliani A, Tiracorrendo M, Mancini M, Venuta F, Rendina EA, Ibrahim M. New perspectives on tracheal resection for COVID-19-related stenosis: A propensity score matching analysis. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00282-4. [PMID: 38555996 DOI: 10.1016/j.jtcvs.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE The large number of patients with COVID-19 subjected to prolonged invasive mechanical ventilation has been expected to result in a significant increase in tracheal stenosis in the next years. The aim of this study was to evaluate and compare postoperative outcomes of patients who survived COVID-19 critical illness and underwent tracheal resection for postintubation/posttracheostomy tracheal stenosis with those of non-COVID-19 patients. METHODS It was single-center, retrospective study. All consecutive patients with post-intubation/posttracheostomy tracheal stenosis who underwent tracheal resection from February 2020 to March 2022 were enrolled. A total of 147 tracheal resections were performed: 24 were in post-COVID-19 patients and 123 were in non-COVID-19 patients. A 1:1 propensity score matching analysis was performed, considering age, gender, body mass index, and length of stenosis. After matching, 2 groups of 24 patients each were identified: a post-COVID-19 group and a non-COVID group. RESULTS No mortality after surgery was registered. Posttracheostomy etiology of stenosis resulted more frequently in post-COVID-19 patients (n = 20 in the post-COVID-19 group vs n = 11 in the non-COVID-19 group; P = .03), as well as intensive care unit admissions during the postoperative period (16 vs 9 patients; P = .04). Need for postoperative reintubation for glottic edema and respiratory failure was higher in the post-COVID-19 group (7 vs 2 postoperative reintubation procedures; P = .04). Postoperative dysphonia was observed in 11 (46%) patients in the post-COVID-19 group versus 4 (16%) patients in the non-COVID-19 group (P = .03). CONCLUSIONS Tracheal resection continues to be safe and effective in COVID-19-related tracheal stenosis scenarios. Intensive care unit admission rates and postoperative complications seem to be higher in post-COVID-19 patients who underwent tracheal resection compared with non-COVID-19 patients.
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Affiliation(s)
- Cecilia Menna
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Silvia Fiorelli
- Division of Anesthesiology and Intensive Care, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Domenico Massullo
- Division of Anesthesiology and Intensive Care, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio D'Andrilli
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Ciccone
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudio Andreetti
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giulio Maurizi
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Camilla Vanni
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessandra Siciliani
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Tiracorrendo
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Mancini
- Morphologic and Molecular Pathology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Federico Venuta
- Division of Thoracic Surgery, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Perroni G, Radovanovic D, Mondoni M, Mangiameli G, Giudici VM, Crepaldi A, Giatti V, Morenghi E, Stella GM, Pavesi S, Mantero M, Corsico AG, Spotti M, Premuda C, Mangili SA, Franceschi E, Narvena VM, Vanoni N, Pilocane T, Russo G, Di Marco F, Alloisio M, Aliberti S, Marulli G, Bertuzzi AF, Cipolla G, Centanni S, Blasi F, Santus P, Cariboni U. Incidence of Tracheal Stenosis in ICU Hospitalized COVID-19 Patients: Results from a Prospective, Observational, Multicenter Study. J Pers Med 2023; 14:39. [PMID: 38248740 PMCID: PMC10817429 DOI: 10.3390/jpm14010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Background: Tracheal stenosis represents a fearsome complication that substantially impairs quality of life. The recent SARS-CoV-2 pandemic increased the number of patients requiring invasive ventilation through prolonged intubation or tracheostomy, increasing the risk of tracheal stenosis. Study design and methods: In this prospective, observational, multicenter study performed in Lombardy (Italy), we have exanimated 281 patients who underwent prolonged intubation (more than 7 days) or tracheostomy for severe COVID-19. Patients underwent CT scan and spirometry 2 months after hospital discharge and a subsequent clinical follow-up after an additional 6 months (overall 8 months of follow-up duration) to detect any tracheal lumen reduction above 1%. The last follow-up evaluation was completed on 31 August 2022. Results: In the study period, 24 patients (8.5%, CI 5.6-12.4) developed tracheal stenosis in a median time of 112 days and within a period of 200 days from intubation. Compared to patients without tracheal stenosis, tracheostomy was performed more frequently in patients that developed stenosis (75% vs 54%, p = 0.034). Tracheostomy and alcohol consumption (1 unit of alcohol per day) increased risk of developing tracheal stenosis of 2.6-fold (p = 0.047; IC 0.99-6.8) and 5.4-fold (p = 0.002; CI 1.9-16), respectively. Conclusions: In a large cohort of patients, the incidence of tracheal stenosis increased during pandemic, probably related to the increased use of prolonged intubation. Patients with histories of prolonged intubation should be monitored for at least 200 days from invasive ventilation in order to detect tracheal stenosis at early stage. Alcohol use and tracheostomy are risk factors for developing tracheal stenosis.
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Affiliation(s)
- Gianluca Perroni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
| | - Dejan Radovanovic
- Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (D.R.); (E.F.); (S.C.); (P.S.)
| | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy; (M.M.); (S.P.)
| | - Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Veronica Maria Giudici
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Alessandro Crepaldi
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
| | - Valentina Giatti
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
| | - Emanuela Morenghi
- Biostatistics Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | - Giulia Maria Stella
- Department of Internal Medicine and Medical Therapeutics, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (G.M.S.); (A.G.C.)
- Unit of Respiratory Diseases, Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Stefano Pavesi
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy; (M.M.); (S.P.)
| | - Marco Mantero
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Angelo Guido Corsico
- Department of Internal Medicine and Medical Therapeutics, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy; (G.M.S.); (A.G.C.)
- Unit of Respiratory Diseases, Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Maura Spotti
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Chiara Premuda
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | | | - Elisa Franceschi
- Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (D.R.); (E.F.); (S.C.); (P.S.)
| | | | - Nicolò Vanoni
- Unit of Pneumology, ASST Lodi, 26900 Lodi, Italy; (N.V.); (G.C.)
| | - Tommaso Pilocane
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Gianluca Russo
- Unit of Pain Medicine, Department of Emergency, ASST Lodi, 26900 Lodi, Italy;
| | - Fabiano Di Marco
- Department of Health Sciences, Università degli Studi di Milano, Pneumologia, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
- Unit of Pneumology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Giuseppe Marulli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | | | - Giuseppe Cipolla
- Unit of Pneumology, ASST Lodi, 26900 Lodi, Italy; (N.V.); (G.C.)
| | - Stefano Centanni
- Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (D.R.); (E.F.); (S.C.); (P.S.)
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.M.); (M.S.); (T.P.); (F.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, L. Sacco University Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, Università Degli Studi di Milano, 20157 Milan, Italy; (D.R.); (E.F.); (S.C.); (P.S.)
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.P.); (V.M.G.); (A.C.); (V.G.); (M.A.); (G.M.); (U.C.)
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