Surgical Intervention for Laryngomalacia: Age-Related Differences in Postoperative Sequelae
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Published on: June 20, 2018
Vijay A Patel1, David Adkins2, Jad Ramadan3
1Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
Insights
Laryngeal surgery for laryngomalacia (LM) is safe in children, but younger patients face longer hospital stays and delays. Recognizing these factors can improve care for pediatric patients.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Healthcare Quality Improvement
Background:
- Laryngomalacia (LM) is a common congenital condition affecting infants, characterized by airway obstruction due to laryngeal cartilage weakness.
- Surgical intervention is sometimes necessary for severe cases of LM to alleviate respiratory distress and improve quality of life.
- Understanding perioperative risks and outcomes is crucial for optimizing care in pediatric patients undergoing laryngeal surgery.
Purpose of the Study:
- To identify risk factors associated with perioperative morbidity in pediatric patients undergoing surgery for laryngomalacia (LM).
- To determine the incidence of postoperative complications, readmissions, and reoperations in this patient population.
- To evaluate the impact of patient age and comorbidities on surgical outcomes.
Main Methods:
- A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program-Pediatric Database (ACS-NSQIP-P) was conducted.
- Data from pediatric patients (<18 years) with LM (ICD-10 code Q31.5) who underwent laryngeal surgery (CPT code 31541) between 2015 and 2017 were abstracted.
- Clinical variables including demographics, comorbidities, hospital setting, length of stay, and postoperative outcomes were analyzed.
Main Results:
- A total of 491 patients were included, with a mean age of 1.07 years.
- Younger patients were more likely to be admitted as inpatients and experience longer delays from admission to surgery and discharge.
- Overall, the incidence of 30-day surgical complications, reintubation, readmission, and reoperation was low across all age groups.
Conclusions:
- Laryngeal surgery is a safe and effective procedure for managing laryngomalacia in children.
- Younger children with LM present unique challenges, including increased likelihood of inpatient admission, delayed procedures, and prolonged hospital stays.
- Optimizing perioperative risk assessment and procedural planning is essential for improving outcomes in this vulnerable pediatric subpopulation.
Objective:
Identify risk factors and determine perioperative morbidity of children undergoing surgery for laryngomalacia (LM).
Methods:
A retrospective analysis of the multi-institutional American College of Surgeons National Surgical Quality Improvement Program-Pediatric Database (ACS-NSQIP-P) was performed to abstract patients aged <18 years with LM (ICD-10 code Q31.5) who underwent laryngeal surgery (CPT code 31541) from 2015 to 2017. Analyzed clinical variables include patient demographics, hospital setting, length of stay, medical comorbidities, postoperative complications, readmission, and reoperation.
Results:
A total of 491 patients were identified, 283 were male (57.6%) and 208 were female (42.4%). The mean age at time of surgery was 1.07 years (range .01-17 years). Younger patients were more likely to undergo surgery in the inpatient setting compared to their counterparts (P < .001). Infants were more likely to have prolonged duration of days from admission to surgery (P < .001), days from surgery to discharge (P < .001), and total length of stay (P<.0010). Finally, there was no significant difference between age groups with respect to 30-day general surgical complications (P = .189), with an overall low incidence of reintubation (1.2%), readmission (3.1%), and reoperation (1.6%).
Conclusion:
This analysis supports laryngeal surgery as a safe surgical procedure for LM. However, younger children are more likely to undergo operative intervention in the inpatient setting, endure delays from hospital admission to surgical intervention, and experience a prolonged length of stay due to their overall medical complexity. Recognition of key factors may assist in optimizing perioperative risk assessment and promote timely procedural planning in this unique pediatric patient subpopulation.
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