Evaluation of Off-Label Postoperative Inhaled Steroid Use in Tracheal and Cricotracheal Resection.

Abstract

Tracheal resection (TR) and cricotracheal resection (CTR) are associated with anastomotic complications. Off-label use of inhaled corticosteroids has gained popularity for reducing tracheal granulation tissue, though adoption remains limited due to unclear safety and efficacy. This study used a national database to evaluate associations between postoperative inhaled steroid use and adverse effects, granulation tissue formation, and repeat surgical intervention. Retrospective cohort study. Multicenter study using TriNetX, a federated electronic health records network. Adult patients undergoing TR/CTR between March 2005 and March 2025 who received inhaled steroids (ciprofloxacin-dexamethasone, dexamethasone, budesonide, fluticasone, mometasone, and beclomethasone) within 1 day postoperatively were included. Patients were excluded if they had diagnoses commonly requiring similar medications or received study agents within 1 month before surgery. Propensity score matching balanced covariates, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for outcomes at 30 days and 3 months. Outcomes included adverse safety events, granulation tissue formation, and repeat airway surgery. The matched cohort included 284 patients in each group. Inhaled steroid use was associated with decreased odds of adverse safety side effects, granulation formation, and repeat airway surgeries at both timepoints, though only repeat procedures at 30 days reached statistical significance (OR 0.60, 95% CI 0.42-0.85). Postoperative inhaled steroid use in TR/CTR patients demonstrated excellent safety with no increased adverse events and was associated with a significant 40% reduction in the incidence of repeat surgeries within 30 days. Further studies should assess potential clinical benefits more definitively.