Comparative Risk Profiles in the Surgical Management of Pediatric Sialorrhea

Area of Science:

• Pediatric Surgery
• Otolaryngology
• Neurology

Background:

• Sialorrhea, or drooling, is a common challenge in children with neurodevelopmental disorders.
• It can lead to serious complications like aspiration and significantly impact quality of life.
• Surgical interventions are often considered to manage severe drooling.

Purpose of the Study:

• To compare the risk profiles of different surgical procedures for managing pediatric sialorrhea.
• To identify factors associated with short-term complications following these surgeries.

Main Methods:

• A retrospective cohort study utilized the American College of Surgeons' National Surgical Quality Improvement Program-Pediatric database (2012-2023).
• Patients undergoing surgery for sialorrhea were analyzed for 30-day outcomes including medical, surgical, and composite morbidity.
• Firth's logistic regression was employed for significant variables identified in univariate analysis.

Main Results:

• Among 295 patients, procedures included botulinum toxin injections (Bot-Sal), salivary duct ligation/re-routing (SDL/R), submandibular gland excision (SMGE), and combined SMGE+SDL/R.
• Compared to Bot-Sal, SDL/R demonstrated significantly lower odds of pulmonary complications (OR 0.18), medical complications (OR 0.15), and composite morbidity (OR 0.37).
• Inpatient status and central nervous system abnormalities were independent risk factors for pulmonary complications.

Conclusions:

• Botulinum toxin injections for sialorrhea in the operating room were linked to higher rates of medical and pulmonary complications in this cohort.
• Salivary duct procedures appear to offer a potentially safer short-term profile regarding specific complications.
• Understanding these short-term complication rates can aid families in making informed decisions about drooling management options.