PMID- 26536285 OWN - NLM STAT- MEDLINE DCOM- 20170803 LR - 20220410 IS - 1531-4995 (Electronic) IS - 0023-852X (Print) IS - 0023-852X (Linking) VI - 126 IP - 6 DP - 2016 Jun TI - Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis. PG - 1390-6 LID - 10.1002/lary.25708 [doi] AB - OBJECTIVES/HYPOTHESIS: Idiopathic subglottic stenosis (iSGS) is a rare and potentially life-threatening disease marked by recurrent and progressive airway obstruction frequently requiring repeated surgery to stabilize the airway. Unknown etiology and low disease prevalence have limited the ability to characterize the natural history of iSGS and resulted in variability in surgical management. It is uncertain how this variation relates to clinical outcomes. STUDY DESIGN: Medical record abstraction. METHODS: Utilizing an international, multi-institutional collaborative, we collected retrospective data on patient characteristics, treatment, and clinical outcomes. We investigated variation between and within open and endoscopic treatment approaches and assessed therapeutic outcomes; specifically, disease recurrence and need for tracheostomy at last follow-up. RESULTS: Strikingly, 479 iSGS patients across 10 participating centers were nearly exclusively female (98%, 95% confidence interval [CI], 96.1-99.6), Caucasian (95%, 95% CI, 92.2-98.8), and otherwise healthy (mean age-adjusted Charlson Comorbidity Index 1.5; 95% CI, 1.44-1.69). The patients presented at a mean age of 50 years (95% CI, 48.8-51.1). A total of 80.2% were managed endoscopically, whereas 19.8% underwent open reconstruction. Endoscopic surgery had a significantly higher rate of disease recurrence than the open approach (chi(2) = 4.09, P = 0.043). Tracheostomy was avoided in 97% of patients irrespective of surgical approach (95% CI, 94.5-99.8). Interestingly, there were outliers in rates of disease recurrence between centers using similar treatment approaches. CONCLUSION: Idiopathic subglottic stenosis patients are surprisingly homogeneous. The heterogeneity of treatment approaches and the observed outliers in disease recurrence rates between centers raises the potential for improved clinical outcomes through a detailed understanding of the processes of care. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1390-1396, 2016. CI - (c) 2015 The American Laryngological, Rhinological and Otological Society, Inc. FAU - Gelbard, Alexander AU - Gelbard A AUID- ORCID: 0000-0003-0078-1305 AD - Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology, Nashville, Tennessee. FAU - Donovan, Donald T AU - Donovan DT AD - Baylor College of Medicine Dept. of Otolaryngology, Houston, Texas. FAU - Ongkasuwan, Julina AU - Ongkasuwan J AD - Baylor College of Medicine Dept. of Otolaryngology, Houston, Texas. FAU - Nouraei, S A R AU - Nouraei SA AD - Imperial College Healthcare NHS Trust Dept. of Otolaryngology, London, United Kingdom. FAU - Sandhu, Guri AU - Sandhu G AD - Imperial College Healthcare NHS Trust Dept. of Otolaryngology, London, United Kingdom. FAU - Benninger, Michael S AU - Benninger MS AD - Cleveland Clinic Dept. of Otolaryngology, Cleveland, Ohio. FAU - Bryson, Paul C AU - Bryson PC AD - Cleveland Clinic Dept. of Otolaryngology, Cleveland, Ohio. FAU - Lorenz, Robert R AU - Lorenz RR AD - Cleveland Clinic Dept. of Otolaryngology, Cleveland, Ohio. FAU - Tierney, William S AU - Tierney WS AD - Cleveland Clinic Dept. of Otolaryngology, Cleveland, Ohio. FAU - Hillel, Alexander T AU - Hillel AT AD - Johns Hopkins University Dept. of Otolaryngology, Baltimore, Maryland. FAU - Gadkaree, Shekhar K AU - Gadkaree SK AD - Johns Hopkins University Dept. of Otolaryngology, Baltimore, Maryland. FAU - Lott, David G AU - Lott DG AD - Mayo Clinic Dept. of Otolaryngology and Pulmonology, Rochester, Minnesota. FAU - Edell, Eric S AU - Edell ES AD - Mayo Clinic Dept. of Otolaryngology and Pulmonology, Rochester, Minnesota. FAU - Ekbom, Dale C AU - Ekbom DC AD - Mayo Clinic Dept. of Otolaryngology and Pulmonology, Rochester, Minnesota. FAU - Kasperbauer, Jan L AU - Kasperbauer JL AD - Mayo Clinic Dept. of Otolaryngology and Pulmonology, Rochester, Minnesota. FAU - Maldonado, Fabien AU - Maldonado F AD - Mayo Clinic Dept. of Otolaryngology and Pulmonology, Rochester, Minnesota. FAU - Schindler, Joshua S AU - Schindler JS AD - Oregon Health and Science University Dept. of Otolaryngology, Portland, Oregon. FAU - Smith, Marshall E AU - Smith ME AD - University of Utah School of Medicine Dept. of Otolaryngology, Salt Lake City, Utah. FAU - Daniero, James J AU - Daniero JJ AD - University of Virginia Health System Dept. of Otolaryngology, Charlottesville, Virginia, U.S.A. FAU - Garrett, C Gaelyn AU - Garrett CG AD - Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology, Nashville, Tennessee. FAU - Netterville, James L AU - Netterville JL AD - Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology, Nashville, Tennessee. FAU - Rickman, Otis B AU - Rickman OB AD - Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology, Nashville, Tennessee. FAU - Sinard, Robert J AU - Sinard RJ AD - Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology, Nashville, Tennessee. FAU - Wootten, Christopher T AU - Wootten CT AD - Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology, Nashville, Tennessee. FAU - Francis, David O AU - Francis DO AD - Vanderbilt University Medical Center Dept. of Otolaryngology and Pulmonology, Nashville, Tennessee. LA - eng GR - K23 DC013559/DC/NIDCD NIH HHS/United States GR - L30 DC012687/DC/NIDCD NIH HHS/United States PT - Journal Article PT - Multicenter Study DEP - 20151104 PL - United States TA - Laryngoscope JT - The Laryngoscope JID - 8607378 SB - IM MH - Airway Obstruction/etiology/*surgery MH - Female MH - Follow-Up Studies MH - Humans MH - Laryngoscopy/methods/*statistics & numerical data MH - Laryngostenosis/complications/pathology/*surgery MH - Larynx/pathology/*surgery MH - Male MH - Middle Aged MH - Recurrence MH - Retrospective Studies MH - Tracheostomy/*statistics & numerical data MH - Treatment Outcome PMC - PMC6198250 MID - NIHMS991460 OTO - NOTNLM OT - Idiopathic subglottic stenosis OT - comparative effectiveness OT - cricotracheal OT - dilation OT - tracheostomy EDAT- 2015/11/05 06:00 MHDA- 2017/08/05 06:00 PMCR- 2018/10/23 CRDT- 2015/11/05 06:00 PHST- 2015/08/24 00:00 [accepted] PHST- 2015/11/05 06:00 [entrez] PHST- 2015/11/05 06:00 [pubmed] PHST- 2017/08/05 06:00 [medline] PHST- 2018/10/23 00:00 [pmc-release] AID - 10.1002/lary.25708 [doi] PST - ppublish SO - Laryngoscope. 2016 Jun;126(6):1390-6. doi: 10.1002/lary.25708. Epub 2015 Nov 4.