Intubated COVID ‐19 Patients More Likely to Develop Subglottic Stenosis

ABSTRACT Objectives Acquired subglottic stenosis (SGS) is commonly caused by prolonged intubation and elevated cuff pressures. Severe COVID‐19 patients requiring extended ventilation are at higher risk of laryngotracheal injury. However, SGS incidence in COVID‐19 versus non‐COVID‐19 patients remains underexplored. To compare the incidence of SGS and frequency of subglottic dilation procedures following intubation in patients with or without a history of recent COVID‐19 infection. Methods Utilizing the TriNetX database, queries were conducted for adult patients intubated between January 20, 2020 and December 31, 2023. Demographics, comorbidities, and COVID‐19 infection histories were collected. Patients were divided into two cohorts based on their COVID‐19 status < 2 weeks prior to hospitalization and propensity‐score matched for demographics and comorbidities. Incidence of SGS and frequency of subglottic dilation/tracheostomy procedures occurring during the same hospitalization as the patient's intubation were compared. Results About 105,443 COVID+ and 79,848 COVID‐ patients had histories of intubation. After matching, each cohort had 70,000 patients; 39% ( N = 54,661) female, 58.5% ( N = 81,852) male. Mean age at time of intubation was 57 years. COVID+ patients were more likely to develop SGS, odds ratio (OR) 1.3 (95% CI 1.1–1.5; p = 0.0004), and more likely to undergo tracheostomy, OR = 1.2 (95% CI = 1.1–1.2; p < 0.001). COVID+ patients with SGS were more likely to undergo subglottic dilation procedures, OR 1.3 (95% CI 1.0–1.7; p = 0.02). There was no significant difference in the number of dilation procedures or mortality rates between cohorts. Conclusions Intubated patients with COVID‐19 were more likely to develop SGS than those without infection and were more likely to require invasive procedures to address complications of long‐term intubation.