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Impact of Pre‐operative Multidisciplinary Evaluation on Laryngotracheal Reconstruction Outcomes
Author(s) -
Wertz Aileen,
Ryan Matthew,
Jacobs Ian,
Piccione Joseph
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.29338
Subject(s) - medicine , retrospective cohort study , esophagogastroduodenoscopy , stenosis , cohort , surgery , laryngotracheal stenosis , logistic regression , endoscopy , airway , tracheal stenosis , radiology
Objective/Hypothesis Determine if diagnostic findings from pre‐operative multidisciplinary evaluations are associated with single surgery or overall success rates in pediatric laryngotracheal reconstruction (LTR). Study Design Retrospective cohort. Methods Retrospective cohort study of patients undergoing LTR at a tertiary care children's hospital between January 01, 2008 and December 31, 2017. Success is defined as decannulation rate if tracheostomy present, and resolution of symptoms if tracheostomy not present. Cohorts compared were those who did and did not receive pulmonary and gastrointestinal preoperative testing. Multivariate, logistic regression, and Kaplan Meier analyses performed. Results About 165 children were included in the study. Median age was 3 years at the time of surgery; 73% of LTRs were double‐stage procedures. Single surgery and overall success rates were 75% and 87%, respectively. After adjusting for severity of stenosis and surgical approach, performing esophagogastroduodenoscopy (EGD) and normal gross appearance on EGD were associated with increased single surgery ( P = .01, .005) and overall success ( P = .005, .0003). Performing pH probe and normal EGD biopsy results was associated with increased overall success ( P = .03, .007). Asthma and musculoskeletal comorbidities, postoperative complications, and need for postoperative balloon dilation were associated with decreased success. No other comorbidities evaluated impacted success. Conclusions Aerodigestive comorbidities are common in children undergoing LTR, and preoperative multidisciplinary workup often results in changes in management. After adjusting for grade and level of stenosis and staged approach, performing EGD and pH/impedance probe as well as normal gross and microscopic EGD findings was independently associated with increased LTR surgical success. Level of Evidence 4 (retrospective cohort study) Laryngoscope , 131:E2356–E2362, 2021