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Impedance probe testing prior to pediatric airway reconstruction
Catherine K Hart1, Alessandro de Alarcon2, Meredith E Tabangin3
1Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA catherine.hart@cchmc.org.
Preoperative impedance testing rarely changed management for airway reconstruction patients, especially those with fundoplication. Patients with fundoplication had poorer surgical outcomes, indicating other factors influence success.
Area of Science:
- Pediatric Otolaryngology
- Gastroenterology
- Surgical Outcomes Research
Background:
- Airway reconstruction is a complex procedure often indicated for subglottic stenosis.
- Gastroesophageal reflux is common in pediatric patients undergoing airway reconstruction and may impact outcomes.
- The role of preoperative impedance testing in guiding management and predicting surgical success is not well-defined.
Purpose of the Study:
- To evaluate if preoperative impedance testing altered management strategies for patients undergoing airway reconstruction.
- To determine the association between impedance testing results and surgical outcomes in this patient population.
Main Methods:
- Retrospective chart review of 57 pediatric patients who underwent airway reconstruction with preoperative impedance testing between January 2010 and September 2011.
- Data collected included demographics, medical and surgical history, impedance testing results, and surgical outcomes.
- Analysis compared outcomes between patients with and without fundoplication and assessed factors influencing surgical success.
Main Results:
- Of 57 patients, 82% were premature and 82% had subglottic stenosis. 63% had gastroesophageal reflux, with 36% having undergone fundoplication.
- Impedance testing changed management in 22% of non-fundoplication patients versus 9.5% of fundoplication patients.
- Fundoplication patients had significantly lower surgical success rates (33% vs. 67%, P = .01), with prematurity, age at surgery, and prior airway surgery also predicting success.
Conclusions:
- Preoperative impedance testing had a limited impact on management changes for airway reconstruction, particularly in patients with a history of fundoplication.
- Patients with fundoplication demonstrated poorer surgical outcomes, suggesting that factors beyond reflux significantly influence the success of airway reconstruction.
- Further research is needed to elucidate the multifactorial influences on airway reconstruction outcomes.
