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Can overnight stenting be safely eliminated following a pharyngeal flap? A matched comparison study
Andre M Wineland1, Jareen Meinzen-Derr2, Paul Willging3
1University of Arkansas School for Medical Sciences, Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, Arkansas.
Insights
Overnight stenting after pharyngeal flap surgery for pediatric velopharyngeal insufficiency (VPI) is not beneficial. Removing nasal stents on postoperative day 0 led to earlier discharge and improved oral intake compared to removal on postoperative day 1.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Speech-Language Pathology
Background:
- Velopharyngeal insufficiency (VPI) affects speech and can be managed with a pharyngeal flap.
- Postoperative management, including nasal stenting, requires optimization for pediatric patients.
Purpose of the Study:
- To determine if overnight stenting is necessary after pharyngeal flap surgery for pediatric VPI.
- To compare outcomes based on the timing of nasal stent removal.
Main Methods:
- Retrospective, age-matched cohort study of pediatric patients undergoing pharyngeal flap surgery for VPI.
- Patients were divided into two groups based on nasal stent removal: postoperative day (POD) 0 or POD 1.
- Primary outcome was postoperative oxygen desaturation; secondary outcomes included length of stay, narcotic use, and oral intake.
Main Results:
- No significant difference in oxygen desaturation between groups.
- Patients with stent removal on POD 0 had a significantly shorter hospital stay (P < 0.0001) and greater oral intake on POD 0 (P = 0.03).
- The POD 0 group had a higher prevalence of genetic syndromes (P = 0.02).
Conclusions:
- Overnight stenting offers no apparent benefit for pediatric patients undergoing pharyngeal flap surgery for VPI.
- Early removal of nasal stents (POD 0) is associated with improved patient outcomes, including earlier hospital discharge.
- No adverse events such as reintubation or hemorrhage were observed with early stent removal.
Objective:
Determine if overnight stenting is warranted after pharyngeal flap for management of velopharyngeal insufficiency (VPI) in pediatric patients METHODS: This is a retrospective age-matched cohort study from a single tertiary pediatric facility. Patients who underwent a posterior pharyngeal flap for VPI from January 1, 2013, to December 31, 2016, were included. Two equal groups were constructed based on when their nasal stents were removed, that is, postoperative day (POD) 0 or POD 1. Primary outcome measure was oxygen desaturation after surgery. Secondary outcome measures were total length of stay, need for narcotics, and oral intake based on POD. Additional information was gathered and evaluated as possible prognostic variables.
Results:
There were 27 matched pairs included in the study. One patient from each group required supplemental oxygen during the night of surgery. No escalation of care was needed in either case. The group whose stents were removed on POD 0 were discharged earlier than the group whose stents were removed on POD 1, P < 0.0001. The POD 0 group took significantly more oral intake on POD 0 than the POD 1 group, P = 0.03. The POD 0 group had significantly more genetic syndromes than the POD 1 group, P = 0.02.
Conclusion:
There was no benefit with overnight stenting. Earlier discharge from the hospital was achieved in the POD 0 group. No patient experienced need for reintubation, escalation of clinical care, postoperative hemorrhage, or death.
Level Of Evidence:
4. Laryngoscope, 128:750-755, 2018.
