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Long-segment tracheal stenosis: slide tracheoplasty and a multidisciplinary approach improve outcomes and reduce
Ergin Kocyildirim1, Mazyar Kanani, Derek Roebuck
1Tracheal Team, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK.
Insights
A multidisciplinary team approach and slide tracheoplasty significantly improve outcomes for children with long-segment tracheal stenosis. This integrated care model reduces mortality and healthcare costs, offering a more effective treatment strategy.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Long-segment tracheal stenosis in children is a rare but severe condition with limited treatment options.
- Management strategies for this condition have historically been controversial and costly.
- The establishment of a dedicated multidisciplinary tracheal team aimed to improve care for referred pediatric airway problems.
Purpose of the Study:
- To evaluate the impact of a multidisciplinary tracheal team on the management of long-segment tracheal stenosis in children.
- To compare surgical outcomes and resource utilization before and after the team's formation.
- To assess the effectiveness of different surgical techniques, specifically slide tracheoplasty versus pericardial patch tracheoplasty and tracheal autograft.
Main Methods:
- A retrospective review of 34 pediatric patients with long-segment tracheal stenosis treated between January 1998 and January 2004.
- Comparison of outcomes between the pre-multidisciplinary team era (pericardial patch tracheoplasty/autograft) and the post-team era (slide tracheoplasty).
- All surgical interventions utilized cardiopulmonary bypass, with simultaneous correction of co-existing cardiac lesions in the later era.
Main Results:
- Mortality rates were significantly higher with pericardial patch tracheoplasty (17-67%) and tracheal autograft (50%) compared to slide tracheoplasty (13%) post-multidisciplinary team formation.
- Slide tracheoplasty, implemented after the team's establishment, demonstrated improved early postoperative survival.
- A significant reduction in intensive care unit and hospital length of stay, along with decreased costs, was observed with the multidisciplinary team approach.
Conclusions:
- A formalized multidisciplinary team approach is crucial for optimizing the management of pediatric long-segment tracheal stenosis.
- Primary slide tracheoplasty should be the preferred surgical technique for this condition.
- This integrated care model leads to improved patient outcomes, reduced mortality, and enhanced resource efficiency.
Objective:
Long-segment tracheal stenosis is rare, life-threatening, difficult, and expensive to treat. Management remains controversial. A multidisciplinary tracheal team was formed in 2000 to deal with a large number of children with airway problems referred for management. We review the effect of that service, comparing the era before and after the establishment of the multidisciplinary tracheal team.
Methods:
From January 1998 through January 2004, 34 patients with long-segment tracheal stenosis (21 patients with cardiovascular anomalies) underwent surgical intervention. Cardiopulmonary bypass was used in all operations. Before the multidisciplinary tracheal team, pericardial patch tracheoplasty with or without an autograft technique was the preferred method of repair. After the multidisciplinary tracheal team, an integrated care plan preferring slide tracheoplasty was initiated, correcting cardiac lesions simultaneously.
Results:
Before the establishment of the multidisciplinary tracheal team, pericardial patch tracheoplasty was performed in 15 of 19 patients. Twelve patients had a suspended pericardial patch tracheoplasty, 2 (17%) of whom died late after the operation. Of 3 patients who had had a simple unsuspended patch, 2 (67%) died early after the operation. Four patients were operated on with the tracheal autograft technique, 2 (50%) dying early in the postoperative period. After multidisciplinary tracheal team formation, in the era between 2001 and 2004, 15 patients were operated on with slide tracheoplasty, and there were 2 (13%) early postoperative deaths. A significant reduction in cost and duration of stay has been shown both in the intensive care unit and the hospital.
Conclusion:
Our data suggest that a formalized multidisciplinary team approach and a policy of primary slide tracheoplasty are beneficial in the management of children with long-segment tracheal stenosis.
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