Evaluating the Association of Clinical Factors With Symptomatic Recurrence of Idiopathic Subglottic Stenosis
Deanna C. Menapace, MD1; Dale C. Ekbom, MD1; David P. Larson, MD1; et al Ian J. Lalich, MD1; Eric S. Edell, MD2; Jan L. Kasperbauer, MD1
Author Affiliations Article Information
1Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
2Department of Pulmonary Medicine, Mayo Clinic, Rochester, Minnesota
JAMA Otolaryngol Head Neck Surg. 2019;145(6):524-529. doi:10.1001/jamaoto.2019.0707
Key Points
Question  Are there clinical factors associated with the symptomatic recurrence of idiopathic subglottic stenosis (iSGS)?

Findings  In this retrospective medical record review of 186 patients with iSGS, patients with class 1 obesity (but not class 2 or 3) showed shorter time to first symptomatic recurrence iSGS than underweight or normal-weight patients. Gastroesophageal reflux disease, hypertension, hyperlipidemia, and diabetes mellitus were associated with increasing body mass index but not with iSGS symptomatic recurrence on multivariable analysis.

Meaning  There appears to be an association between class 1 obesity and time to first symptomatic iSGS recurrence, but the mechanisms of disease progression are yet to be fully understood.

Abstract
Importance  Idiopathic subglottic stenosis (iSGS) is a progressive and potentially life-threatening condition with very few targeted treatment options.

Objective  To characterize the clinical factors of patients with iSGS, including body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), and evaluate their association with iSGS symptomatic recurrence.

Design, Setting, and Participants  This retrospective medical record review included 186 adult patients with iSGS treated at a single tertiary referral center between January 1, 1989, and December 31, 2015. All data analysis took place from January 1, 2018 to June 30, 2018.

Main Outcomes and Measures  The 3 BMI categories were examined for their association with iSGS recurrence. Outcome measurements included time to first symptomatic recurrence (TTFR) and recurrence-free survival (RFS). Comorbidities were recorded.

Results  Of the 186 patients in the study, 182 (98%) were women; mean (interquartile range) patient age, 49 (41-60) years. At iSGS diagnosis, 65 (35%) patients were underweight or normal weight; 45 (24%) were overweight; and 76 (41%) were obese (class 1, 2, or 3). Median BMI was 27.4. Ninety-one patients experienced TTFR at a median of 14 months. Compared with underweight or normal-weight patients, the hazard ratios for the associations of overweight, obese class 1, and obese class 2/3 patients with recurrence were 1.14 (95% CI, 0.65-1.99), 1.74 (95% CI, 1.04-2.93), and 1.04 (95% CI, 0.54-1.99), respectively. No differences in concomitant medical treatment regimens were found. While several comorbidities (gastroesophageal reflux disease, hypertension, hyperlipidemia, and diabetes mellitus) were associated with increasing BMI, they were not associated with iSGS symptomatic recurrence on multivariable analysis.

Conclusions and Relevance  Results of this retrospective review show that class 1 obesity was associated with an increased rate of iSGS symptomatic recurrence compared with underweight or normal-weight patients. This association was not seen in class 2 or class 3 obesity. Patients with class 1 obesity should be counseled about this risk to aid in the assessment and management of symptoms.