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Complications of pediatric laryngotracheal reconstruction: prevention strategies
J P Ludemann1, C A Hughes, Z Noah
1Division of Pediatric Otolaryngology, The Children's Memorial Hospital and Northwestern University, Chicago, Illinois, USA.
Insights
Postoperative infections like respiratory syncytial virus (RSV) bronchiolitis and pseudomonal wound abscess (PWA) significantly increase complications after pediatric laryngotracheal reconstruction (LTR) and cricotracheal resection (CTR). Prevention and GERD treatment are crucial for better outcomes.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Critical Care Medicine
Background:
- Laryngotracheal reconstruction (LTR) and cricotracheal resection (CTR) are complex procedures for pediatric airway stenosis.
- Postoperative complications can significantly impact patient outcomes and resource utilization.
Purpose of the Study:
- To quantify postoperative complications and outcomes following LTR and CTR in pediatric patients.
- To identify risk factors associated with LTR failure and restenosis.
- To propose strategies for infection prevention and management.
Main Methods:
- Retrospective chart review of 82 consecutive LTR and CTR cases over 9 years.
- Identification and analysis of postoperative infections, including respiratory syncytial virus (RSV) bronchiolitis and pseudomonal wound abscess (PWA).
- Statistical analysis to determine associations between infections, comorbidities, and surgical outcomes.
Main Results:
- 12 patients experienced infections (6 RSV bronchiolitis, 8 PWA) after single-stage LTR/CTR.
- RSV bronchiolitis and PWA were linked to increased intubation, ICU stay, and LTR failure.
- Cricoid cartilage ossification, grade IV subglottic stenosis, and untreated GERD correlated with restenosis.
- Trisomy 21 did not significantly affect LTR success.
Conclusions:
- RSV bronchiolitis and PWA are significant, potentially preventable complications of pediatric LTR/CTR.
- Management of GERD during healing is recommended to prevent restenosis.
- Implementing preventative strategies for RSV and PWA can improve pediatric airway reconstruction outcomes.
Abstract:
A retrospective chart review was performed to quantify the postoperative complications and outcomes of 82 consecutive cases of laryngotracheal reconstruction (LTR) and cricotracheal resection (CTR) performed at a pediatric tertiary care hospital over the last 9 years. Six cases of respiratory syncytial virus (RSV) bronchiolitis and 8 cases of cervical pseudomonal wound abscess (PWA) were identified in a total of 12 patients. All of these infections occurred after single-stage LTR or CTR. Both RSV bronchiolitis and PWA were associated with significantly more unexpected days of intubation and admission to the intensive care unit, as well as higher rates of failure of LTR. Ossification of the cricoid cartilage, grade IV subglottic stenosis, and untreated gastroesophageal reflux disease (GERD) were also associated with restenosis. Trisomy 21 did not significantly influence the success rate of pediatric LTR. Both RSV bronchiolitis and PWA are potentially preventable complications of pediatric LTR and CTR. We propose strategies to prevent these infections. We also advocate the treatment of GERD during the healing phase of LTR.