title: Development and validation of a new outcome score in subglottic stenosis.
abstract: BACKGROUND
  We prospectively evaluated a clinical and endoscopic score, the tracheal endoscopic clinical score (TECS), developed as a disease-specified outcome measure in adult patients undergoing operation for subglottic stenosis. We also performed a retrospective chart review to identify preoperative and intraoperative risk factors for worse TECS.
  
  
  METHODS
  The TECS includes endoscopic (vocal cord and glottic function, anastomotic healing, and patency) and interview (respiration, voice, swallow) variables, and was administered at 6-month follow-up. Endoscopic and subjective domains were weighted to obtain a continuous TECS index ranging from 0 (best) to 1 (worse). The TECS and preoperative variables relationships were evaluated by univariate and multivariate analysis.
  
  
  RESULTS
  We collected data (January 2009 to December 2010) from 30 patients (mean age, 48.3±19 years) undergoing subglottic resection and primary reconstruction. Stenosis etiology was postintubation (n=8), idiopathic (n=2), tracheostomy (n=18), and malignant (n=2). Surgery included Pearson operation with (n=7) or without (n=23) a Liberman-Mathisen cricoplasty. Mean length of resected trachea was 30.5±13.5 mm, and mean hospital stay was 7.4 days. Mortality rate was 1 patient (3.3%). The univariate analysis showed positive correlation between 6-month TECS and degree of stenosis (McCaffrey and Cotton scale 0 to 4) stage 4, tracheostomy or T-tube at surgery, bottleneck-type transition stenosis, and resection length. At multivariate analysis, the presence of tracheostomy, bottleneck-type transition stenosis and resection length were indicators of worse postoperative functional result.
  
  
  CONCLUSIONS
  The TECS seems to be a valid and simple instrument to identify preoperative variables predicting worse results and to assess postoperative outcome. Validation on larger series is necessary.
authors.affiliation: European Center of Thoracic Research, University Hospital Careggi, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gonfiotti
authors.forename: Massimo Osvaldo
authors.initials: MO
authors.lastname: Jaus
authors.forename: Daniel
authors.initials: D
authors.lastname: Barale
authors.forename: Silvia
authors.initials: S
authors.lastname: Baiguera
authors.forename: Leonardo
authors.initials: L
authors.lastname: Polizzi
authors.forename: Philipp
authors.initials: P
authors.lastname: Jungebluth
authors.forename: Matteo
authors.initials: M
authors.lastname: Paoletti
authors.forename: Massimo
authors.initials: M
authors.lastname: Pistolesi
authors.forename: Paolo
authors.initials: P
authors.lastname: Macchiarini
mesh_terms: D000328:Adult; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D007829:Laryngostenosis / Q000175:diagnosis*; D015203:Reproducibility of Results; D012720:Severity of Illness Index