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Postoperative observation of children after endoscopic type 1 posterior laryngeal cleft repair
Nathan S Alexander1, Judy Z Liu2, Bharat Bhushan3
1Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Otolaryngology-Head and Neck Surgery, Chicago, Illinois, USA Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Greenville Health System, Greenville, South Carolina, USA.
Insights
Endoscopic repair of type 1 posterior laryngeal cleft (PLC) is a successful treatment for pediatric patients, improving symptoms in most cases. Safe management in observation units without intubation significantly reduces costs.
Area of Science:
- Pediatric Otolaryngology
- Laryngeal Surgery
- Minimally Invasive Procedures
Background:
- Posterior laryngeal cleft (PLC) is a congenital anomaly affecting breathing and feeding in children.
- Type 1 PLC is the most common form, often requiring surgical intervention.
- Endoscopic repair offers a less invasive approach compared to traditional open surgery.
Purpose of the Study:
- To evaluate the perioperative management and surgical outcomes of pediatric patients undergoing endoscopic repair of type 1 PLC.
- To assess the safety and efficacy of managing these patients in observation units postoperatively.
- To analyze the cost-effectiveness of the endoscopic approach.
Main Methods:
- A retrospective case series of 54 pediatric patients with type 1 PLC who underwent endoscopic carbon dioxide laser-assisted repair.
- Data collected via chart review from January 2006 to December 2012.
- Comparison of outcomes between patients managed in observation units versus pediatric intensive care units.
Main Results:
- Symptom improvement in 76% of patients (41/54), primarily for aspiration and chronic bronchitis.
- No postoperative complications or need for intubation.
- Patients managed in observation units experienced similar outcomes to those in the PICU, with significant cost savings.
- Two patients required revision surgery.
Conclusions:
- Endoscopic repair of type 1 PLC is a safe and effective procedure with low morbidity.
- Postoperative management in observation units without intubation is feasible and cost-effective.
- This approach leads to substantial reductions in healthcare costs for pediatric PLC treatment.
Objectives:
To report the perioperative management and surgical outcomes in a large series of pediatric patients with endoscopically repaired type 1 posterior laryngeal cleft (PLC).
Study Design:
Case series with chart review.
Setting:
Urban, tertiary care, free-standing pediatric hospital.
Subjects And Methods:
Patients who underwent endoscopic carbon dioxide laser-assisted repair of type 1 posterior laryngeal clefts between January 2006 and December 2012. Medical records were reviewed.
Results:
Fifty-four patients (34 male) underwent repair of type 1 PLC. Median age was 25.5 months (range, 2-120 months). Indications for repair included aspiration (n = 39; 72%), chronic bronchitis (n = 13; 24%), and stridor with feeds (n = 2; 4%). No children remained intubated postoperatively. Thirty-three patients (61%) stayed in overnight observation ("Obs PLC") and 21 patients (39%) stayed in the pediatric intensive care unit ("PICU PLC") postoperatively. Between Obs PLC and PICU PLC groups, there was no significant difference in age (mean 22 vs 30 months, respectively; P = .28). Comorbidities were similar between the groups. Symptoms improved in 41 of the 54 patients (76%). No postoperative complications were noted. Two patients required revision PLC repair. The cost of admitting a patient to a lower acuity location was estimated to be 60% less per day than cost of a PICU admission.
Conclusions:
The endoscopic surgical repair of a type 1 PLC is successful and has a low morbidity and complication rate. Patients may be safely managed in an observation unit and without postoperative intubation. This approach achieved a marked cost reduction in postoperative care.
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