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

Objective 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 three 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. Median resection length was 25mm (range: 8-70mm). The median hospital length of stay was 6 days (IQR 5-9). 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 (2%) dehiscences. 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 patients (1.4%) underwent a permanent tracheostomy. Conclusions This large, contemporary, international cohort of airway cases demonstrates that complications following airway resections are significantly lower than previously reported. This finding is crucial for informed and shared decision-making with patients suffering from operable airway conditions.