• Login
    View Item 
    •   UMB Digital Archive
    • UMB Open Access Articles
    • UMB Open Access Articles 2019
    • View Item
    •   UMB Digital Archive
    • UMB Open Access Articles
    • UMB Open Access Articles 2019
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Browse

    All of UMB Digital ArchiveCommunitiesPublication DateAuthorsTitlesSubjectsThis CollectionPublication DateAuthorsTitlesSubjects

    My Account

    LoginRegister

    Statistics

    Display statistics

    Comparative Treatment Outcomes for Patients with Idiopathic Subglottic Stenosis

    • CSV
    • RefMan
    • EndNote
    • BibTex
    • RefWorks
    Author
    Gelbard, A.
    Anderson, C.
    Guardiani, E.A.
    Date
    2019
    Journal
    JAMA Otolaryngology - Head and Neck Surgery
    Publisher
    American Medical Association
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1001/jamaoto.2019.3022
    Abstract
    Importance: Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research. Objective: To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease. Design, Setting, and Participants: In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook. Main Outcomes and Measures: The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications. Results: Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score-matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk. Conclusions and Relevance: In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.
    Keyword
    Laryngostenosis
    Treatment Outcome
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85074663517&doi=10.1001%2fjamaoto.2019.3022&partnerID=40&md5=5e7b2b5d6ad409ead7eaa14dad30f18a; http://hdl.handle.net/10713/11433
    ae974a485f413a2113503eed53cd6c53
    10.1001/jamaoto.2019.3022
    Scopus Count
    Collections
    UMB Open Access Articles 2019

    entitlement

    Related articles

    • Outcomes after cricotracheal resection for idiopathic subglottic stenosis.
    • Authors: Carpenter PS, Pierce JL, Smith ME
    • Issue date: 2018 Oct
    • Idiopathic Subglottic Stenosis: Long-Term Outcomes of Open Surgical Techniques.
    • Authors: Menapace DC, Modest MC, Ekbom DC, Moore EJ, Edell ES, Kasperbauer JL
    • Issue date: 2017 May
    • [Effect of partial cricotracheal resection and extended cricotracheal resection for severe laryngotracheal stenosis].
    • Authors: Cui PC, Zhao DQ, Guo ZH, Liang LP, Wang W
    • Issue date: 2020 Feb 7
    • Cricotracheal resection for adult subglottic stenosis: Factors predicting treatment failure.
    • Authors: Jethwa AR, Hasan W, Palme CE, Mäkitie AA, Espin-Garcia O, Goldstein DP, Gilbert RW, Keshavjee S, Pierre A, Gullane PJ
    • Issue date: 2020 Jul
    • Primary cricotracheal resection with thyrotracheal anastomosis for the treatment of severe subglottic stenosis in children and adolescents.
    • Authors: Alvarez-Neri H, Penchyna-Grub J, Porras-Hernandez JD, Blanco-Rodriguez G, Gonzalez R, Rutter MJ
    • Issue date: 2005 Jan
    DSpace software (copyright © 2002 - 2021)  DuraSpace
    Quick Guide | Policies | Contact Us | UMB Health Sciences & Human Services Library
    Open Repository is a service operated by 
    Atmire NV
     

    Export search results

    The export option will allow you to export the current search results of the entered query to a file. Different formats are available for download. To export the items, click on the button corresponding with the preferred download format.

    By default, clicking on the export buttons will result in a download of the allowed maximum amount of items.

    To select a subset of the search results, click "Selective Export" button and make a selection of the items you want to export. The amount of items that can be exported at once is similarly restricted as the full export.

    After making a selection, click one of the export format buttons. The amount of items that will be exported is indicated in the bubble next to export format.