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Is Outpatient Supraglottoplasty Possible? Examination of Perioperative Comorbidities and Outcomes
Courtney N Wright1, Isabella Zaniletti2, Charles Mullins1
1Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Insights
Supraglottoplasty (SGP) for laryngomalacia (LM) is safe for select infants in an outpatient setting. This study found no significant difference in readmission rates between same-day discharge and overnight observation groups.
Area of Science:
- Pediatric Otolaryngology
- Surgical Outcomes Research
Background:
- Congenital laryngomalacia (LM) affects 10-15% of infants, often requiring supraglottoplasty (SGP).
- Postoperative management after SGP varies, impacting patient outcomes and resource utilization.
Purpose of the Study:
- To evaluate the outcomes and readmission rates of infants undergoing supraglottoplasty (SGP).
- To compare patient outcomes based on length of hospital stay following SGP.
Main Methods:
- Retrospective chart review of 975 patients undergoing SGP from 2012-2022.
- Patients were categorized into three groups based on length of stay (LOS): 0, 1, or 2+ days.
- Analysis included preoperative factors, postoperative care, complications, and readmission rates.
Main Results:
- 23.8% of patients were discharged same-day (Group 0), 63.2% observed overnight (Group 1), and 13.0% stayed 2+ days (Group 2).
- Readmission rates were 1.3% for Group 0 and 2.9% for Group 1, not statistically significant.
- Group 2 patients exhibited higher rates of comorbidities and specific postoperative interventions.
Conclusions:
- Supraglottoplasty (SGP) is a safe procedure for select infants with laryngomalacia (LM).
- Outpatient management following SGP is feasible for carefully selected pediatric patients.
- Further research can refine criteria for same-day discharge after SGP.
Objective:
Supraglottoplasty (SGP) is necessary in approximately 10% to 15% of infants with congenital laryngomalacia (LM). Postoperative management strategies vary and this study examines outcomes and readmission rates.
Study Design:
This is a retrospective chart review.
Setting:
A single tertiary care institution's patients undergoing SGP from 2012 to May 2022.
Methods:
Patients were assigned to 1 of 3 groups based on length of stay (LOS) including 0, 1, or 2+ days. Preoperative data included age, prevailing symptoms, and comorbidities at the time of surgery. Postoperative data included level of care, perioperative complications, readmission rates, and SGP failure. Descriptive statistics were used to evaluate differences between the 3 groups.
Results:
Following SGP in 975 patients, 23.8% were discharged the same day (Group 0), 63.2% were observed overnight (Group 1), and 13.0% required 2+ days (Group 2). Four of the 616 patients in Group 1 were admitted to an intensive care unit (ICU) setting, and 11 patients in Group 2. The patients in Group 2 had a higher incidence of Pepcid use, previous intubation, cardiac anomalies, prior gastrostomy tube (G tube), subglottic stenosis, cyanosis, failure to thrive, and prematurity. The significant differences in the group admitted to the ICU were those admitted for airway, cerebral palsy, prior G tube, PSG, prior intubation, or cardiac anomaly (P = <.05). Readmission rates from Group 0 versus 1 were 1.3% and 2.9%, respectively, though this was not statistically significant.
Conclusion:
SGP is a safe procedure that can be performed in the outpatient setting in select patients.
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