Journal article
Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis
JAMA otolaryngology-- head & neck surgery, Vol.146(1), pp.20-29
01/01/2020
DOI: 10.1001/jamaoto.2019.3022
PMCID: PMC6824232
PMID: 31670805
Abstract
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.
To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease.
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.
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.
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.
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.
Details
- Title: Subtitle
- Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis
- Creators
- Alexander Gelbard - Vanderbilt UniversityCatherine Anderson - Vanderbilt UniversityLynne D Berry - Vanderbilt UniversityMilan R Amin - New York UniversityMichael S Benninger - Cleveland ClinicJoel H Blumin - Medical College of WisconsinJonathan M Bock - Medical College of WisconsinPaul C Bryson - Cleveland ClinicPaul F Castellanos - University of Alabama at BirminghamSheau-Chiann Chen - Vanderbilt UniversityMatthew S Clary - University of Colorado DenverSeth M Cohen - Duke UniversityBrianna K Crawley - Loma Linda UniversitySeth H Dailey - University of Wisconsin–MadisonJames J Daniero - University of VirginiaAlessandro de Alarcon - University of CincinnatiDonald T Donovan - Baylor College of MedicineEric S Edell - Mayo ClinicDale C Ekbom - Mayo ClinicSara Fernandes-Taylor - University of Wisconsin–MadisonDaniel S Fink - University of Colorado DenverRamon A Franco - Harvard UniversityC Gaelyn Garrett - Vanderbilt UniversityElizabeth A Guardiani - University of Maryland, BaltimoreAlexander T Hillel - Johns Hopkins UniversityHenry T Hoffman - University of IowaNorman D Hogikyan - University of MichiganRebecca J Howell - University of CincinnatiLi-Ching Huang - Vanderbilt UniversityLena K Hussain - Vanderbilt UniversityMichael M Johns III - Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los AngelesJan L Kasperbauer - Mayo ClinicSid M Khosla - University of CincinnatiCheryl Kinnard - Vanderbilt UniversityRobbi A Kupfer - University of Michigan–Ann ArborAlexander J Langerman - Vanderbilt UniversityRobert J Lentz - Vanderbilt UniversityRobert R Lorenz - Medical College of WisconsinDavid G Lott - Mayo Clinic in FloridaAnne S Lowery - Vanderbilt UniversitySamir S Makani - University of California, San DiegoFabien Maldonado - Vanderbilt UniversityKyle Mannion - Vanderbilt UniversityLaura Matrka - The Ohio State UniversityAndrew J McWhorter - Louisiana State University Health Sciences Center New OrleansAlbert L Merati - University of WashingtonMatthew C Mori - New York Eye and Ear InfirmaryJames L Netterville - Vanderbilt UniversityKarla O'Dell - University of Southern CaliforniaJulina Ongkasuwan - Baylor College of MedicineGregory N Postma - Augusta UniversityLindsay S Reder - University of Southern CaliforniaSarah L Rohde - Vanderbilt UniversityBrent E Richardson - Bastian Voice Institute, Downers Grove, IllinoisOtis B Rickman - Vanderbilt UniversityClark A Rosen - University of California, San FranciscoMichael J Rutter - University of CincinnatiGuri S Sandhu - Imperial College LondonJoshua S Schindler - Oregon Health & Science UniversityG Todd Schneider - University of RochesterRupali N Shah - University of North Carolina at Chapel HillAndrew G Sikora - Baylor College of MedicineRobert J Sinard - Vanderbilt UniversityMarshall E Smith - University of UtahLibby J Smith - University of PittsburghAhmed M S Soliman - Temple UniversitySigríður Sveinsdóttir - Landspítali University Hospital, Reykjavik, IcelandDouglas J Van Daele - University of IowaDavid Veivers - Royal North Shore HospitalSunil P Verma - University of California, IrvinePaul M Weinberger - Louisiana State University Health Sciences Center ShreveportPhilip A Weissbrod - University of California, San DiegoChristopher T Wootten - Vanderbilt UniversityYu Shyr - Vanderbilt UniversityDavid O Francis - Cleveland Clinic
- Resource Type
- Journal article
- Publication Details
- JAMA otolaryngology-- head & neck surgery, Vol.146(1), pp.20-29
- DOI
- 10.1001/jamaoto.2019.3022
- PMID
- 31670805
- PMCID
- PMC6824232
- NLM abbreviation
- JAMA Otolaryngol Head Neck Surg
- ISSN
- 2168-6181
- eISSN
- 2168-619X
- Language
- English
- Date published
- 01/01/2020
- Academic Unit
- Radiation Oncology; Medicine Administration; Otolaryngology
- Record Identifier
- 9984312245202771
Metrics
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