Complications following airway resections: Insights from a large contemporary multi-institutional cohort

Background: Airway surgery remains a rarely performed procedure and reports on complication rates are scarce in the literature. Given several recent technical advances in airway surgery, we aimed to assess the rates of procedure-associated complications in a contemporary, multi-institutional cohort of patients. Methods: Airway resections performed between January 2013 and December 2023 in 3 European institutions with a dedicated airway program were included in this retrospective analysis. Results: A total of 640 patients were included in the analysis. This included 313 tracheal, 309 cricotracheal, and 18 laryngotracheal reconstructions with rib cartilage interpositions. The median length of resection was 25 mm (range, 8-70 mm). The median hospital length of stay was 6 days (interquartile range, [IQR], 5-9 days). In-hospital mortality was recorded in 2 patients (0.3%). The most prevalent early complication was glottic swelling (5%), followed by surgical site infection (4%). Anastomosis dehiscence was a rare event, with 12 partial dehiscences (2%). Most patients (93%) experienced normal healing of their anastomosis. Granuloma formation was noted in 3.3% of patients, restenosis in 3.1%, and malacia in 0.2%. With a median follow-up of 2 years and 5 months (IQR, 4-47 months), only 5 patients (0.7%) required a stent, 2 (0.3%) required a T-tube, and 9 (1.4%) underwent a permanent tracheostomy. Conclusions: This large, contemporary, international cohort of airway cases demonstrates that complications following airway resection are significantly lower than previously reported. This finding is crucial for informed and shared decision making with patients suffering from operable airway conditions.