Comparative Risk Profiles in the Surgical Management of Pediatric Sialorrhea

Sialorrhea commonly affects patients with neurodevelopmental disorders, resulting in aspiration risk and reduced quality of life. This study aims to compare the risk profiles for the surgical management of pediatric sialorrhea.

A retrospective cohort study was performed using the American College of Surgeons' National Surgical Quality Improvement Program-Pediatric database (2012-2023) of patients undergoing surgery for sialorrhea in the operating room. 30-day outcomes included medical complications, surgical complications, length of stay, unplanned reintubation, reoperation, readmission, and composite morbidity. Clinically relevant, significant variables on univariate analysis were retained for Firth's logistic regression.

Among 295 patients, 23% received botulinum injections (Bot-Sal), 56% salivary duct ligation or re-routing (SDL/R), 10% submandibular gland excision alone (SMGE), and 11% combined SMGE + SDL/R. Compared with Bot-Sal, SDL/R was associated with lower odds of pulmonary complications (OR 0.18, 95% CI 0.06-0.56, p = 0.003), medical complications (OR 0.15, 95% CI 0.05-0.45, p = 0.001), and composite morbidity (OR 0.37, 95% CI 0.15-0.90, p = 0.027). Inpatient status (OR 5.04, 95% CI 1.87-13.62, p = 0.001) and CNS abnormalities (OR 2.70, 95% CI 1.07-6.79, p = 0.035) were independently associated with increased risk of pulmonary complications. There were no significant differences in surgical complications by procedure.

Botulinum injections to the salivary glands in the operating room were associated with increased medical complications, specifically pulmonary, in this dataset, likely reflecting a combination of patient selection, clinical context, and procedural factors. Short-term complication rates may help guide families regarding options for drooling procedures in the OR.