Original article
General thoracic
Predictors for Postoperative Complications After Tracheal Resection

https://doi.org/10.1016/j.athoracsur.2014.03.019Get rights and content

Background

Tracheal resection and anastomosis is the gold standard for the treatment of tracheal stenosis. The objective of this study is to evaluate the complications after tracheal resection for benign stenosis and the predicting factors for such complications.

Methods

A retrospective study was made involving patients with benign tracheal or laryngotracheal stenosis who underwent surgical resection and reconstruction between February 2002 and January 2009. Complications related and unrelated to the anastomosis were studied. Categorical variables were presented as percentage and continuous variables as mean and standard deviation. Predicting factors were determined by univariate analysis. Factors with p less than 0.05 were used for multivariate regression. Logistic regression models were also employed for dependent variables. Statistical significance was set for p less than 0.05.

Results

Ninety-four patients (18 female, 76 male) were included. Complications occurred in 42 (44.6%). Twenty-one percent had anastomotic complications. The most common complication was restenosis (16%). Nonanastomotic complications occurred in 23.2%. Wound infection occurred in 10.6%. Clinical comorbidities, previous tracheal resection, and the length of tracheal resection were statistically significant factors for complications. Previous tracheal resection was the most significant factor and was highly associated with anastomotic complications (odds ratio 49.965, p = 0.012). The greatest number of complications was found in the laryngotracheal reconstruction group, and in resections more than 4 cm. Mean follow-up was 19 ± 14 months. At the end of the study, 86 patients (91.4%) were breathing normally. There was no mortality in this series.

Conclusions

Comorbidities, previous tracheal resection, and the length of tracheal resection more than 4 cm were statistically significant factors for the onset of complications.

Section snippets

Material and Methods

This retrospective study included patients who underwent tracheal or laryngotracheal resection with primary reconstruction at our division of thoracic surgery between February 2002 and January 2009. Our institution is a tertiary teaching hospital and a national referral center for tracheal diseases. Data were collected from medical records, and all patients were assigned a code number to ascertain confidentiality of information. This project was submitted and approved by the hospital's Ethics

Results

The flow of the patients is depicted in Figure 1. During the study period, 138 patients with laryngotracheal stenosis underwent operation. Forty-four patients were excluded from the study (10 patients had incomplete medical records; 28 underwent laryngeal split and cartilaginous grafting; and 6 had miscellaneous etiologies). Ninety-four patients (18 women and 76 men) were eventually included in the study. Patient demographics and the characteristics of the study group are depicted in Table 1.

Of

Comment

In the present study, the overall complication rate was 44.6%, with no mortality. Restenosis was the most frequent complication, occurring in 16% of the patients. The factors associated with anastomotic complications were the presence of comorbidities, previous tracheal resection, and the extent of the resection.

The overall morbidity after tracheal resection varies from 17% to 45% 3, 7, 8, 9, 10, 11, and mortality ranges from 0% to 2.4% 3, 7, 8, 9, 10. The high variability rates of

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