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Slide tracheoplasty: Predictors of outcomes and literature review
Aileen Wertz1, Stephanie M Fuller2, Christopher Mascio2
1Division of Otolaryngology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Insights
Slide tracheoplasty is a safe and effective procedure for treating tracheal stenosis in children. Factors like concomitant cardiac surgery, younger age, lower weight, preoperative mechanical ventilation, and smaller airway diameter are associated with adverse postoperative outcomes.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Airway Reconstruction
Background:
- Tracheal stenosis is a serious condition in children, often requiring complex surgical intervention.
- Slide tracheoplasty is a reconstructive technique used to widen the narrowed trachea.
Purpose of the Study:
- To identify preoperative comorbidities and intraoperative factors linked to adverse postoperative outcomes following slide tracheoplasty.
- To evaluate the safety and effectiveness of slide tracheoplasty in pediatric patients.
Main Methods:
- Retrospective case series conducted at a single tertiary care children's hospital.
- Data collected from 2010 to 2017, including patient demographics, surgical parameters, and postoperative outcomes.
- Statistical analysis to determine correlations between preoperative/intraoperative factors and outcomes.
Main Results:
- Slide tracheoplasty demonstrated an overall success rate of 87% in 26 pediatric patients (median age 6 months).
- Concomitant cardiac surgery was linked to a higher incidence of postoperative tracheostomy (p=0.04).
- Younger age and lower weight at surgery correlated with longer intubation and hospitalization durations. Preoperative mechanical ventilation and smaller airway diameter were associated with extended hospital stays.
Conclusions:
- Slide tracheoplasty is a safe and effective surgical option for pediatric tracheal stenosis.
- Specific factors, including concomitant cardiac surgery, preoperative mechanical ventilation, and airway dimensions, influence postoperative outcomes.
- Findings can aid in family counseling and guide future research on slide tracheoplasty.
Objective:
Determine preoperative comorbidities and intraoperative parameters associated with adverse postoperative outcomes.
Methods:
Retrospective case series at a single tertiary care children's hospital from 2010 through 2017.
Results:
Twenty-six patients with median age of 6 months and median weight of 7.1 kg underwent slide tracheoplasty. Median time to extubation, length of intensive care unit admission, and length of hospitalization were 7, 27, and 30 days, respectively. Twenty-two (85%) required no additional intervention. Overall success was 87%. One (4%) patient required open revision, and 3 (11%) required tracheostomy. Concomitant cardiac surgery was associated with postoperative tracheostomy (p = 0.04). Age and weight at surgery were inversely correlated with length of intubation (p = 0.03) and length of hospital stay (p = 0.001, p = 0.002) respectively. Hospital stay was 2.2 times longer if preoperative mechanical ventilation was required (p = 0.01) and 39% longer for every 1 mm decrease in airway diameter at the narrowest portion of the stenosis (p = 0.005). There were no deaths related to persistent tracheal stenosis with a median follow-up of 24 months.
Conclusion:
Slide tracheoplasty is safe and effective. Concomitant cardiac surgery was associated with postoperative tracheostomy. Lower age and weight at surgery were correlated with longer length of intubation and hospital stay. Preoperative mechanical ventilation and smaller airway diameter were associated with longer hospital stay. This information may be helpful in counseling families and planning future prospective studies.
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