(0805) COVID-19 Infection as a Risk Factor for the Development of Adult Laryngotracheal Stenosis

Introduction: Anywhere from 1 to 10% of patients receiving endotracheal intubation are later diagnosed with acquired laryngotracheal stenosis (ALTS). This study aims to determine whether patients intubated due to COVID-19 develop ALTS at higher rates than those intubated for non-COVID illness.

Methods: Adults admitted to Temple University Hospital or Jeanes Hospital who were intubated due to COVID-19 between February 1, 2020 and December 31, 2022 and had a post-extubation CT scan were included. A matched group of patients who were COVID- and intubated during the same period served as a control group. Outcome variables included airway symptoms, radiographic evidence of stenosis and other comorbidities. Cohort descriptive statistics were analyzed using chi squared and unpaired 2 tailed T-tests.

Results: In total, 208 patients were included with 104 in each group. There were 37 (35.6%) female patients in the COVID+ group and 40 (38.5%) in the COVID- group (p = 0.6058). Average BMI in the COVID+ group was 31.15 and 29.06 for the COVID- group (p = 0.1460). Average endotracheal tube size was 7.72 for the COVID+ group and 7.8 in the COVID- group (p = 0.1677). COVID+ patients were intubated for a mean 7.74 days vs 3.79 days for COVID- patients (p = 0.001). A sum of 34 (32.7%) COVID+ patients were proned while no COVID- patients were proned (p = 0.0917). Steroids were given to 75 (72.1%) COVID+ patients vs 36 (34.6%) COVID- patients (p = 0.0007). COPD was diagnosed in 26 (25%) COVID+ patients vs 45 (43.3%) COVID- patients (p = 0.0336). There was a history of smoking in 48 (46.1%) COVID+ patients compared to 74 (71.15%) COVID- (p = 0.0001). Just 7 patients had diagnosed ALTS, 6 (5.8%) being COVID+ and 1 (0.96%) COVID- (p = 0.0365).

Conclusions: COVID+ patients were more likely to develop ALTS than COVID- while controlling for risk factors like BMI and endotracheal tube size. However, they were intubated for longer, were more likely to be proned and treated with steroids. COVID- patients were likely intubated due to poor respiratory status (COPD, smoking history) despite not having COVID. The groups did not differ in sex, tube size, and BMI.