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Readmission and reoperation after laryngeal dilation in children: NSQIP-P analysis
Nicole M Favre1, Afreen A Siddiqui1, Adam R Szymanowski2
1Department of Otolaryngology - Head and Neck Surgery, Jacobs School of Medicine & Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA.
Insights
Younger children and those without a tracheostomy face higher risks of complications after laryngeal dilation. Understanding these factors is crucial for setting expected outcomes in pediatric airway management.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Laryngeal dilation is a critical intervention for pediatric airway obstruction.
- Comorbidities and patient factors significantly influence outcomes in pediatric surgical procedures.
- Identifying risk factors for adverse events is essential for optimizing patient care.
Purpose of the Study:
- To investigate comorbidities associated with laryngeal dilation in children.
- To compare outcomes between children with and without a tracheostomy.
- To analyze age-related differences in complications following laryngeal dilation.
Main Methods:
- Retrospective analysis of the American College of Surgeons National Surgical Improvement - Pediatric Database (2015-2018).
- Patient cohort identified using Current Procedural Terminology code 31528.
- Analysis of demographics, comorbidities, and post-operative outcomes including readmission, reoperation, reintubation, and length of stay.
Main Results:
- Younger children (≤1 year) had significantly higher rates of comorbidities like prematurity and cardiac risk factors.
- Children without a tracheostomy showed higher prevalence of comorbidities including asthma and chronic lung disease.
- Younger children and those without a tracheostomy experienced significantly higher rates of reintubation, return to the operating room, and longer hospital stays.
Conclusions:
- Younger age and absence of a tracheostomy are significant predictors of adverse outcomes after pediatric laryngeal dilation.
- These findings highlight the need for tailored management strategies and outcome benchmarks for high-risk pediatric populations undergoing laryngeal dilation.
Objective:
To identify specific comorbidities and their relationship to complications in children who underwent laryngeal dilation, specifically comparing children with tracheostomy versus no tracheostomy as well as differences in outcomes between age groups.
Methods:
Retrospective study analyzing data collected in the American College of Surgeons National Surgical Improvement - Pediatric Database (2015-2018). Patients were selected using Current Procedural Terminology code 31528. Variables analyzed include demographics, comorbidities, readmission, reoperation, reintubation and total length of stay.
Results:
982 cases were identified. Comorbidities significantly higher (p < .001) in age group 1 (Age ≤ 1 year, N = 245) versus age groups 2 (Age >1 but ≤ 3 years, N = 151) and 3 (Age > 3 years, N = 270) include premature birth, ventilator dependent, oxygen support, cardiac risk factors, steroid use, nutritional support, and hematologic disorders. Comorbidities significantly higher (p < .001) in children without a tracheostomy include premature birth, history of asthma, bronchopulmonary dysplasia/chronic lung disease, oxygen support, structural pulmonary/airway abnormality, esophageal/gastric/intestinal disease, history of previous cardiac surgery, developmental delay/impaired cognitive status, cerebral palsy, neuromuscular disorder, steroid use, and nutritional support. Younger children were significantly more likely (p < .001) to require reintubation and remain in the hospital longer. Children without a tracheostomy were significantly more likely (p < .001) to return to the operating room and remain in the hospital longer.
Conclusion:
Younger children and those without a tracheostomy are more likely to have adverse outcomes after laryngeal dilation. Awareness of these associations and outcomes is helpful in establishing benchmarks for outcomes in this group.
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