Safety of open airway reconstruction in high-risk post-COVID patients: A case-matched control study

OBJECTIVES: COVID-19 pneumonia patients may have high rates of intubation and reduced pulmonary function once recovered. Poor pulmonary function is a relative contraindication to open airway reconstruction, post-COVID patients may extrapolate as high-risk for open airway reconstruction. This presents challenges in airway stenosis management of post-COVID pneumonia patients. This study reports the safety and outcomes of open airway reconstruction in carefully selected post-COVID patients. METHODS: A retrospective case-matched control study of six post-COVID tracheal stenosis cases treated with tracheal resection and six matched controls. Controls were matched based on age, length of stenosis, and comorbidities. Primary outcomes are peri-operative safety events and need for future airway interventions. RESULTS: Post-COVID cases and non-COVID controls were closely matched on age, length of stenosis, and comorbidities (p > 0.05). Duration of follow-up was not significantly different (p = 0.1894). No patients required reintubation, tracheostomy, ICU admission, or ventilator placement in the peri-operative period. There was one allergic reaction to antibiotics in a case and one aspiration pneumonia in a control. One case required in-office steroid injection and injection augmentation post-operatively, but no patients from either group required future operative airway intervention during the follow-up period. CONCLUSION: Post-COVID tracheal stenosis cases had comparably excellent outcomes with matched controls after open tracheal construction, with few peri-operative safety events and minimal need for future interventions. These data indicate open airway reconstruction is a safe and effective option for the treatment of tracheal stenosis in carefully selected post-COVID patients. LEVEL OF EVIDENCE: 4: