Characterizing Disease Severity Through Surgical Recurrence Rates in Idiopathic Subglottic Stenosis

There is currently not a marker of disease severity in idiopathic subglottic stenosis (iSGS). Our objective was to characterize iSGS patients' disease severity using endoscopic surgery rates.

This was a two-center retrospective analysis of iSGS patients with a minimum of 4 years of follow up following an initial endoscopic procedure (laser wedge excision (LWE) or endoscopic dilation (ED)). Disease severity was classified into Groups A-C, based on whether patients had fewer (Group A), the same number (Group B), or more surgeries (Group C) in years 3-5 compared to years 1 and 2. Disease severity proportions were compared across institutions using chi-square analysis. Nonparametric testing compared clinical characteristics such as age, BMI, and GERD across severity groups.

There were 104 patients from institution 1 and 53 patients from institution 2 that were all female and predominantly Caucasian. Both institutions had clinically and statistically similar proportions of patients in Group A (64% vs. 62%), Group B (20% vs. 19%), and Group C (16% vs. 19%) disease (p > 0.05). No clinical characteristic (e.g., age, sex, race, BMI, GERD) was associated with disease severity.

Across tertiary care institutions there is a consistent proportion of iSGS patients who either demonstrate nonrecurrent/decelerating (Group A), stable but persistent (Group B), or rapidly recurring disease (Group C). Two-year surgery rates appear to be an important timepoint for providing expectations to patients on the likelihood of possessing severe disease.