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Supraglottoplasty outcomes in relation to age and comorbid conditions
Stephen R Hoff1, James W Schroeder, Jeff C Rastatter
1Department of Otolaryngology-Head and Neck Surgery, University of Illinois Medical Center at Chicago, Chicago, IL, USA.
Insights
Younger infants undergoing supraglottoplasty for severe laryngomalacia had higher revision rates. Comorbidities, especially neurologic and cardiac conditions, significantly increased the need for tracheostomy in these children.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Surgery
Background:
- Severe laryngomalacia often requires surgical intervention, such as supraglottoplasty.
- The impact of patient age and comorbid conditions on outcomes after supraglottoplasty is not fully understood.
Purpose of the Study:
- To investigate the effect of age and comorbid conditions on outcomes following supraglottoplasty for severe laryngomalacia in children.
Main Methods:
- Retrospective study of 56 children who underwent supraglottoplasty for severe laryngomalacia.
- Outcomes assessed included persistent airway obstruction, need for revision supraglottoplasty, and tracheostomy.
Main Results:
- Younger infants (<2 months) without comorbidities had higher revision supraglottoplasty rates (36.4%) compared to older infants (5.3%).
- Patients with comorbidities were diagnosed later and had higher rates of revision surgery (47.8%) and tracheostomy (39.1%).
- Neurologic and cardiac comorbidities were associated with significantly higher rates of revision surgery and tracheostomy.
Conclusions:
- Age at the time of supraglottoplasty is a critical factor for noncomorbid patients, with younger infants experiencing poorer outcomes.
- Comorbid conditions, particularly neurologic and cardiac issues, are significant predictors of adverse outcomes, including the need for tracheostomy.
Objective:
To determine if age and comorbid conditions effect outcomes in children undergoing supraglottoplasty for severe laryngomalacia.
Design:
Retrospective study.
Setting:
Urban tertiary-care children's hospital.
Patients:
Children undergoing supraglottoplasty for severe laryngomalacia between February 2004 and July 2008. 56 patients were identified.
Outcome Measures:
Persistence of upper airway obstruction, revision surgery (supraglottoplasty), and additional surgery (tracheostomy).
Results:
33/56 (58.9%) patients had no comorbid conditions and 23/56 (41.1%) patients had comorbid conditions. In noncomorbid patients, 36.4% of those less than 2 months of age at the time of surgery required revision supraglottoplasty, compared to 5.3% of patients between 2 and 10 months (p<0.05). Compared to the 2-10-month age group, there was a significantly higher percentage of patients with comorbid conditions in the >10-month group (32.1% vs. 79%, p<0.01). Patients with comorbid conditions were diagnosed at a significantly later age than those without (6 mo vs. 2 mo, respectively), and had significantly higher rates of revision supraglottoplasty (47.8% vs. 18.2%) and tracheostomy (39.1% vs. 0.0%). 70% of children with neurological conditions required revision surgery, with 60% requiring tracheostomy. The revision surgery and tracheostomy rates were significantly higher compared to the noncomorbid group (p<0.01 and p<0.0001). Children with cardiac conditions had a higher rate of tracheostomy than noncomorbid children (30% vs. 0%, p<0.01). 16.7% of children with genetic conditions required supraglottoplasty, and none required tracheostomy.
Conclusions:
In noncomorbid patients, those undergoing supraglottoplasty less than 2 months of age had a significantly higher rate of revision supraglottoplasty. Patients with neurologic and cardiac comorbidities require tracheostomy at a significantly higher rate than noncomorbid patients.
