(0317) Intubated COVID-19 Patients Are More Likely to Develop Subglottic Stenosis

Introduction: Subglottic stenosis (SGS) may develop as a sequela of prolonged intubation in critically ill patients. This study compared the incidence of SGS and frequency of subglottic dilation procedures following intubation in patients with or without a history of recent COVID-19 infection.

Methods: Utilizing the TriNetX database, queries were conducted for adult patients intubated December 2019-2023. Demographics, comorbidities, and COVID-19 infection histories were collected. Subsequent surgeries, including subglottic dilation procedures and tracheostomies, were analyzed to determine if they occurred during the same hospitalization as the patient’s intubation. Patients were divided into cohorts based on their COVID-19 status less than 2 weeks prior to hospitalization and propensity-score matched for demographics and comorbidities.

Results: Initial TriNetX search resulted in 105,443 COVID+ and 79,848 COVID- patients with histories of intubation. After propensity-score matching, each cohort had 70,000 patients; 39% (n = 54,661) female, 58.5% (n = 81,852) male. Mean age at time of intubation was 57 years. COVID+ patients were more likely to develop SGS (n = 444, 0.63%) than COVID- patients (n = 345, 0.5%), odds ratio (OR) 1.3 (95% CI 1.1-1.5; p = 0.0004). COVID+ patients with SGS (n = 154, 0.22%) were also more likely to undergo subglottic dilation procedures than COVID- patients (N = 116, 0.17%), OR 1.3 (95% CI 1.0-1.7; p = 0.02). There was no significant difference in number of dilation procedures between cohorts. In patients who were intubated and underwent dilation (n = 102 in each cohort), incidence of tracheotomy was not significantly different between groups (n = 35, 34.3% in COVID+ group, n = 40, 39.2% in COVID- group, p = 0.5). 26 (25.5%) COVID+ and 28 (27.5%) COVID- patients died, with no significant difference in mortality (p = 0.929).

Conclusions: Intubated COVID+ in contrast to non-covid infected patients had a greater propensity to develop SGS and undergo subglottic dilation procedures, suggesting the potential for an association between subglottic complications post-intubation for patients with COVID-19 infection.