The impact of early surgical treatment of tracheal stenosis on neurorehabilitation outcome in patients with severe acquired brain injury

Introduction Acquired tracheal stenosis (TS) is a potentially life-threatening condition following prolonged intubation and/or tracheostomy in adult patients with severe Acquired Brain Injury (sABI), requiring a tracheal resection and reconstruction. Methods We included 38 sABI adult patients with TS, admitted at a post-acute Neurorehabilitation Hospital. Disability Rating Scale (DRS) and other functional assessment measures were recorded at admission (t(1)), before TS surgical treatment (t(2)), and at discharge (t(3)). Patients were defined as 'improved' when they changed from a more severe to a less severe disability, between time t(2) and time t(3), and as "not improved" when they did not show any further improvement between t(2) and t(3), or they already exhibited a disability improvement since time interval t(1)-t(2). Results Time interval between the injury onset and TS surgical treatment (t(2)-t(0)) was associated with the patient's disability improvement, suggesting the t(2)-t(0) time interval <= 115 days as a cutoff value for a possible functional recovery. A t(2)-t(0) time interval <= 170 days is also associated to absence of persistent dysphagia. Conclusions Early TS surgical treatment within 115 days from the injury onset contributes to the improvement of the disability level in patients with sABI, optimizing their functional outcomes and recovery potential.