Rate of early restenosis after tracheal resection in patients post-COVID-19 infection: a multicenter real-life study

Background: The coronavirus disease 2019 (COVID-19) pandemic has led to a rise in tracheal stenosis (TS) due to prolonged invasive ventilation. Limited data are available on outcomes following tracheal resection and anastomosis (TRA) in this specific population. This study aimed to evaluate early restenosis, postoperative complications, and reintervention rates after TRA in a real-world, multicenter setting. Methods: This prospective, observational study included patients who developed TS after invasive mechanical ventilation for COVID-19 and underwent tracheal or laryngotracheal resection across five highvolume thoracic surgery centers in Italy (June 2020 to December 2023). The primary endpoint was restenosis incidence; secondary endpoints included complication rates and in-hospital mortality. Results: Ninety patients (mean age: 58.4 +/- 11.5 years; 62% male) were included. Most patients (81%) developed stenosis post-tracheostomy; 35% had failed prior endoscopic treatments, while 65% underwent upfront surgery. Major and overall complication rates were 7.8% and 30%, respectively. Early restenosis (defined as restenosis occurring within 90 days from surgery) occurred in 8 patients (8.8%) at a mean of 34.2 +/- 26.0 days. Interventions included endoscopic dilatation (n=4), stenting (n=1), and tracheostomy (n=3). interval (CI): 1.45-103.2, P=0.02] and diabetes (HR 8.64, 95% CI: 1.12-66.3, P=0.03) as independent predictors of early restenosis. Conclusions: TRA in post-COVID-19 patients, when performed in high-volume centers, is safe and effective, with low restenosis and complication rates. However, early restenosis may occur, particularly in patients with comorbidities or prior endoscopic procedures. Close bronchoscopic follow-up is warranted within the first months postoperatively to enable timely detection and management.