title: Predictors of Posterior Glottic Stenosis: A Multi-Institutional Case-Control Study.
abstract: OBJECTIVE
  To assess intrinsic and extrinsic risk factors in the development of posterior glottic stenosis (PGS) in intubated patients.
  
  
  METHODS
  Patients diagnosed with PGS between September 2012 and May 2014 at 3 tertiary care university hospitals were included. Patient demographics, comorbidities, duration of intubation, endotracheal tube (ETT) size, and indication for intubation were recorded. Patients with PGS were compared to control patients represented by patients intubated in intensive care units (ICU).
  
  
  RESULTS
  Thirty-six PGS patients were identified. After exclusion, 28 PGS patients (14 male, 14 female) and 112 (65 male, 47 female) controls were studied. Multivariate analysis demonstrated ischemia (P < .05), diabetes (P < .01), and length of intubation (P < .01) were significant risk factors for the development of PGS. Fourteen of 14 (100%) males were intubated with a size 8 or larger ETT compared to 47 of 65 (72.3%) male controls (P < .05). Posterior glottic stenosis (P < .01), length of intubation (P < .001), and obstructive sleep apnea (P < .05) were significant risk factors for tracheostomy.
  
  
  CONCLUSIONS
  Duration of intubation, ischemia, diabetes mellitus, and large ETT size (8 or greater) in males were significant risk factors for the development of PGS. Reducing the use of size 8 ETTs and earlier planned tracheostomy in high-risk patients may reduce the incidence of PGS and improve ICU safety.
authors.affiliation: Johns Hopkins University School of Medicine, Otolaryngology, Head & Neck Surgery, Baltimore, Maryland, USA ahillel@jhmi.edu.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Hillel
authors.affiliation: Johns Hopkins University School of Medicine, Otolaryngology, Head & Neck Surgery, Baltimore, Maryland, USA.
authors.forename: Selmin
authors.initials: S
authors.lastname: Karatayli-Ozgursoy
authors.affiliation: Johns Hopkins University School of Medicine, Otolaryngology, Head & Neck Surgery, Baltimore, Maryland, USA.
authors.forename: Idris
authors.initials: I
authors.lastname: Samad
authors.affiliation: Johns Hopkins University School of Medicine, Otolaryngology, Head & Neck Surgery, Baltimore, Maryland, USA.
authors.forename: Simon R A
authors.initials: SR
authors.lastname: Best
authors.affiliation: Johns Hopkins University School of Medicine, Otolaryngology, Head & Neck Surgery, Baltimore, Maryland, USA.
authors.forename: Vinciya
authors.initials: V
authors.lastname: Pandian
authors.affiliation: Emory University School of Medicine, Department of Otolaryngology, Head & Neck Surgery, Atlanta, Georgia, USA.
authors.forename: Laureano
authors.initials: L
authors.lastname: Giraldez
authors.affiliation: Emory University School of Medicine, Department of Otolaryngology, Head & Neck Surgery, Atlanta, Georgia, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gross
authors.affiliation: Vanderbilt University Medical Center, Department of Otolaryngology, Head & Neck Surgery, Nashville, Tennessee, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wootten
authors.affiliation: Vanderbilt University Medical Center, Department of Otolaryngology, Head & Neck Surgery, Nashville, Tennessee, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gelbard
authors.affiliation: Johns Hopkins University School of Medicine, Otolaryngology, Head & Neck Surgery, Baltimore, Maryland, USA.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Akst
authors.affiliation: Emory University School of Medicine, Department of Otolaryngology, Head & Neck Surgery, Atlanta, Georgia, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Johns
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D007511:Ischemia / Q000150:complications; D007829:Laryngostenosis / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications; D013997:Time Factors; D014139:Tracheostomy; D016896:Treatment Outcome
keywords: fibrosis; hospital safety; intubation; laryngotracheal stenosis; tracheostomy