Recorded Social Context, Care Intervals, and Six-Month Outcomes in Laryngotracheal Stenosis: A 20-Year South African Cohort Study

Abstract Background/Objective: Evidence on recorded social context, care intervals, and airway outcomes in laryngotracheal stenosis (LTS) is limited in resource-constrained settings. This 20-year tertiary cohort described record-derived social context and examined associations of recorded diagnostic and treatment intervals with baseline stenosis severity and six-month composite success. Methods: This retrospective cohort included 126 consecutive adults with LTS, all of whom had undergone tracheostomy at some stage, treated at a South African tertiary referral centre from 2005 to 2024. The record-derived A-SCAT was summarised descriptively and was not analysed as an exposure. Six-month composite success was defined as sustained clinically satisfactory decannulation at six months after index LTS treatment, requiring decannulation by that assessment, Cotton-Myer grade I-II, mMRC dyspnoea grade 0–1, and no re-tracheostomy or unplanned further therapeutic airway intervention before assessment. Robust logistic regression estimated associations per six-month care-interval increase, adjusting for aetiology, comorbidity count, and baseline severity in the treatment-delay model. Results: Median age was 30 years (IQR 23–42); 80/126 (63.5%) were male and 92/126 (73.0%) had grade III-IV stenosis. Six-month composite success was achieved in 68/126 (54.0%; Wilson 95% CI 45.3–62.4): 30/34 (88.2%) in grade I-II and 38/92 (41.3%) in grade III-IV. Neither diagnostic interval (adjusted odds ratio [aOR] 1.06, 0.94–1.19; p = 0.371) nor severity-adjusted treatment delay (aOR 1.08, 0.98–1.19; p = 0.142) was associated with six-month composite success. Diagnostic interval was not associated with baseline high-grade stenosis (aOR 0.97, 0.86–1.08; p = 0.565). A post hoc, exploratory restriction to diagnostic intervals ≤ 24 months changed the severity estimate, indicating outlier-driven model instability rather than a protective effect of longer delay. Conclusions: Approximately half of this selected tertiary cohort of previously tracheostomized adults achieved six-month composite success. Advanced baseline stenosis was associated with substantially lower unadjusted composite success. Recorded care-interval associations were imprecise and sensitive to extreme values. They neither exclude delay-related harm nor support causal treatment comparisons. Prospective multicentre studies should record exact pathway dates and independently adjudicate outcomes.