Decannulation in Revision Pediatric Laryngotracheal Reconstruction

• Published in: The Laryngoscope Vol. 134; no. 4; p. 1926
• Main Authors: Leonard, James A, Blumenthal, Daniel L, Behzadpour, Hengameh K, Lawlor, Claire M, Preciado, Diego
• Format: Journal Article
• Language: English
• Published: United States 01.04.2024
• Subjects: laryngotracheal stenosis; airway; pediatric
• ISSN: 1531-4995
• DOI: 10.1002/lary.30985

To evaluate how patient characteristics and surgical techniques influence the rate of and time to decannulation after pediatric revision laryngotracheal reconstruction. The study was a retrospective cohort investigation of children with a history of laryngotracheal stenosis treated between 2008 and 2021 with revision open airway surgery. The primary outcome evaluated was decannulation. The secondary outcome analyzed was time to decannulation. Thirty-nine children were included in the study with median age 49 months; 61.5% were male. Children undergoing single stage revision surgery were far more likely to be decannulated (OR 6.25, 95% CI 1.33-45.97, p = 0.0343). Rolling logistic regression of the probability of decannulation stratified by time between open surgeries demonstrated significantly decreased chance of decannulation with reoperation within 6 months. Children managed with anterior/posterior grafting compared with a single graft were observed to have an increased time to decannulation, (HR 0.365, 95% CI 0.148-0.899, p = 0.005, Log-Rank). We observe that in the case of revision pediatric open airway surgery, chance of decannulation is improved when surgery is performed in a single stage as well as 6 months after the most recent procedure. Patients and families should be counseled that complex stenosis requiring double stage procedures or anterior/posterior grafting is associated with a decreased probability of decannulation and increased postoperative time with a tracheostomy, respectively. 4 Laryngoscope, 134:1926-1932, 2024.