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Original Investigation
January 10, 2019

Association Between Red Blood Cell Distribution Width and Outcomes of Open Airway Reconstruction Surgery in Adults

Author Affiliations
  • 1Vanderbilt University School of Medicine. Nashville, Tennessee
  • 2Surgical Outcomes Center for Kids, Vanderbilt University Medical Center. Nashville, Tennessee
  • 3Division of Otolaryngology, Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
  • 4Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA Otolaryngol Head Neck Surg. Published online January 10, 2019. doi:10.1001/jamaoto.2018.3793
Key Points

Question  Is red blood cell distribution width at the time of open airway reconstruction associated with the likelihood of achieving a prosthesis-free airway?

Findings  In this case series study of 92 patients with laryngotracheal stenosis who underwent open airway reconstruction, 74 were prosthesis free at last follow-up. Airway decannulation was significantly correlated with reduced red blood cell distribution width and the absence of posterior glottic stenosis.

Meaning  In adult patients undergoing open airway reconstruction, red blood cell distribution width may provide some insight into the preoperative probability of prosthesis removal and help patients make informed decisions.

Abstract

Importance  Airway reconstruction for adults with laryngotracheal stenosis (LTS) is directed toward improving airway caliber to mitigate the patient’s dyspnea and achieve prosthesis-free breathing (ie, without tracheostomy, intraluminal stent, or T-tube). Despite the importance of preoperative risk stratification to minimize postoperative complications, consensus on an objective predictive algorithm for open airway reconstruction is lacking.

Objective  To determine whether the ability to achieve a prosthesis-free airway in adults after open airway reconstruction is associated with red blood cell distribution width (RDW) at the time of surgery.

Design, Setting, and Participants  Case series study investigating 92 consecutive patients 18 years and older with laryngotracheal stenosis who underwent open airway reconstruction at a US tertiary care hospital from January 1, 2006, to January 1, 2017.

Main Outcomes and Measures  The main outcome was a prosthesis-free airway (absence of tracheostomy, intraluminal stent, or T-tubes) at last follow-up. Multivariate logistic regression modeling was used to identify independent factors associated with this outcome.

Results  Of the 92 patients who met inclusion criteria, the median (interquartile range) age was 44 (33.0-60.3) years; 50 (53%) were female, and 82 (89%) were white. In all, 74 patients (80%) were prosthesis free at the last follow-up (mean, 833 days; 95% CI, 10-4229 days). In multivariate analyses, airway decannulation was significantly correlated with reduced RDW (odds ratio [OR], 0.40; 95% CI, 0.19-0.84) and the absence of posterior glottic stenosis (OR, 0.12; 95% CI, 0.04-0.37).

Conclusions and Relevance  These data suggest that surgical success in open airway reconstruction is significantly associated with RDW and whether the patient had posterior glottic stenosis. The RDW is a routine laboratory parameter that may provide some insight to the preoperative probability of prosthesis removal, facilitate risk stratification, promote informed patient decision making, and optimize health care resource management.

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