Colonization by Staphylococcus aureus Predicts Postoperative Complications After Tracheoplasty for Airway Stenosis

Background Tracheoplasty offers definitive treatment for high-grade tracheal stenosis but carries a high risk of postoperative complications. While structural and clinical predictors have been widely studied, the influence of airway colonization and antibiotic prophylaxis remains unclear. The objective of this study was to identify clinical, anatomical, and microbiological predictors of postoperative complications in patients undergoing tracheal resection and end-to-end anastomosis. Methods We conducted a retrospective cohort study of 87 adult patients who underwent tracheoplasty at a national referral center. Demographic, anatomical, surgical, and microbiological data were collected. Airway colonization was defined by positive cultures obtained preoperatively. Prophylactic antibiotic use was defined as systemic antibiotics administered within 24 hours of surgery. Multivariable logistic regression was used to identify predictors of overall and specific complications. Results At least one postoperative complication occurred in 39% of patients, with 26% occurring at the anastomosis site. Predictors of complications included multisegmental or complex stenosis, higher Cotton classification, and greater intraoperative blood loss. Airway colonization with Staphylococcus aureus was a strong independent predictor of several complications, including pneumonia (OR 21.7, q = 0.002), tracheitis, dehiscence, and surgical reintervention. Colonization with drug-resistant or multiple organisms further increased risk. Viral isolates had no measurable impact on outcomes. Despite being administered in 80% of patients, protocolized antibiotic prophylaxis showed no association with reduced complications or infection-related events. Conclusions Microbiological colonization, particularly with S. aureus , is a key predictor of adverse outcomes after tracheoplasty, independent of structural severity or comorbidities. Our results support the need for microbiology-informed perioperative strategies to reduce morbidity. Trial registration: This was a retrospective observational cohort study conducted using routinely collected clinical data. As no intervention was prospectively assigned and no randomization or protocol-driven treatment allocation was performed, this study does not qualify as a clinical trial and was therefore not registered.