Idiopathic subglottic stenosis can be treated successfully with single-stage cricotracheal resection and reconstruction. Practice varies on the use of a temporary protective tracheostomy at the time of surgery to mitigate the risk of airway obstruction from postoperative laryngeal edema. The effects of a protective tracheostomy on outcomes are unclear, and the subject of this study. 
A retrospective single-institution review of patients who underwent a cricotracheal resection with or without a protective tracheostomy from January 1, 1994 to August 31, 2015 was performed. The primary outcome was the rate of post-operative complications. Secondary outcomes were recurrence of stenosis and characteristics of the post-operative course. Eleven patients did not have a protective tracheostomy, and 27 did. The overall post-operative complication rate was 37%; 55% in the non-tracheostomy group and 30% in the tracheostomy group (p=0.15). Airway-related complications in the tracheostomy group were significantly lower, 15% compared to 55% in the non-tracheostomy group (p=0.01). The rate of recurrent stenosis was greater in the non-tracheostomy group, with 4 patients (36%) developing re-stenosis requiring dilation, while there was one patient (4%) in the tracheostomy group (p=0.01). The overall hospital length of stay was similar in both groups, at 10.1 days and 11.7 days (p=0.19). The ICU length of stay (3.8 vs 1.2 days, p=0.001) and days on the ventilator (2.8 vs. 1.1 days, p=0.01) were less in the tracheostomy group. 
In our series, the use of a protective tracheostomy was associated with fewer post-operative airway complications, a shorter duration on the ventilator and a shorter ICU stay. It is a safe approach in the single-stage cricotracheal resection and reconstruction.

Idiopathic subglottic stenosis: outcomes with or without the use of protective tracheostomy in single-stage cricotracheal resection