Outcomes Following Single-Stage Laryngotracheal Reconstruction Using a "No Look" Extubation Philosophy

This study aims to examine outcomes following single-stage laryngotracheal reconstruction (SSLTR) using a "no look" philosophy.

Case series with chart review.

Two urban, tertiary, children's hospitals.

Patients underwent primary or revision open SSLTR by 1 of 3 surgeons at 2 institutions. After a period of planned postoperative intubation, patients were extubated in the pediatric intensive care unit (PICU), with operative inspection of the airway deferred for 6 weeks unless symptoms of stridor or distress developed postoperatively. Short-term and long-term clinical outcome metrics were examined.

From 2011 to 2021, 47 consecutive SSLTRs were completed, following which patients were extubated in the PICU without antecedent inspection of the airway. The mean age was 30.8 months (range: 3-130 months), and the mean preoperative stenosis grade was 2.1. There were 17 anterior grafts, 1 isolated posterior graft, and 29 A/P graft procedures; 19% of surgeries were revisions of prior open procedures. The mean PICU and hospital length of stay were 10.1 and 12.5 days, respectively. The failure rate following extubation was 4% (0% primary and 22% revision, P < .003), and 23% of patients had an unplanned return to the operating room for airway symptoms (21% primary and 33% revision, P = .44). Secondary endoscopic interventions were performed in 47% of cases; when required, the mean number of dilations was 2.2 (1.6 primary and 3.7 revision, P < .05). Long-term outcomes compared favorably with historical standards.

In select patients undergoing SSLTR, a "no look" philosophy may eliminate unnecessary surgical procedures without compromising short-term or long-term clinical outcomes.