Barriers to Decannulation After Double‐Stage Laryngotracheal Reconstruction

Koenigs, Maria B; Behzadpour, Hengameh; Zalzal, George H.; Preciado, Diego

doi:10.1002/lary.29486

Cited by 6 publications

(11 citation statements)

References 29 publications

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“…The decannulation rate after dsLTP in the literature ranges from 65% to 89%. [8][9][10][11][12][13] In our study, the overall decannulation rate was 74% with a significantly higher rate in patients with low-grade stenosis after stent removal (84%) compared with those with high-grade stenosis after stent removal (36%). This suggests dsLTP is a frequently successful procedure for pediatric SGS with decannulation outcomes predicted by early endoscopy findings.…”

Section: Discussionmentioning

confidence: 45%

“…The decannulation rate after dsLTP in the literature ranges from 65% to 89% 8–13 . In our study, the overall decannulation rate was 74% with a significantly higher rate in patients with low‐grade stenosis after stent removal (84%) compared with those with high‐grade stenosis after stent removal (36%).…”

Section: Discussionmentioning

confidence: 46%

“…Koenigs et al reported five endoscopic interventions prior to decannulation in 43.9% of their dsLTP population. 11 Agrawal et al reported 4.6 endoscopic procedures in their dsLTP patients and Khatib et al noted 3.31 endoscopic procedures in patients decannulated compared with 1.29 in those not decannulated. 9,10 Our results indicate that children with high-grade stenosis postoperatively are likely to need more interventions prior to being successfully decannulated and emphasize the importance of postoperative endoscopic procedures in improving outcomes after dsLTP.…”

Section: Discussionmentioning

confidence: 99%

“…These results are consistent with findings in other studies. 9,11 Although children with significant comorbidities might be expected to remain tracheostomy-dependent longer, this has not been shown in the literature. One possible explanation is that most studies reporting open airway reconstruction results are limited to single-center experiences with small sample sizes unable to detect differences.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are comparable with other studies in the literature. Koenigs et al reported five endoscopic interventions prior to decannulation in 43.9% of their dsLTP population 11 . Agrawal et al reported 4.6 endoscopic procedures in their dsLTP patients and Khatib et al noted 3.31 endoscopic procedures in patients decannulated compared with 1.29 in those not decannulated 9,10 .…”

Section: Discussionmentioning

confidence: 99%

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Surgical Outcomes by Early Airway Endoscopy Findings after Pediatric Staged Laryngotracheoplasty

et al. 2023

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ObjectivesTo determine how initial postoperative airway endoscopy findings after stent removal predict successful decannulation in children undergoing double‐staged laryngotracheoplasty (dsLTP). Secondary objectives assessed timing of decannulation and number of endoscopic interventions needed after dsLTP.MethodsA case series with chart review included children who underwent dsLTP at a tertiary children's hospital between 2008 and 2021. Rates of decannulation, time to decannulation, and number of interventions after dsLTP were recorded for children with high‐ or low‐grade stenosis at the first bronchoscopy after stent removal.ResultsOf the 65 children who were included, 88% had high‐grade stenosis and 98% had a preoperative tracheostomy. Successful decannulation happened in 74% of the children, and 44% of the children were decannulated within 12 months of surgery. For children with low‐grade stenosis at the first endoscopy after stent removal, 84% were successfully decannulated compared with 36% of the children with high‐grade stenosis (p = 0.001). After dsLTP, children with high‐grade stenosis required 7.5 interventions (SD: 3.3) compared with 4.0 interventions (SD: 3.0) for children with low‐grade stenosis (p < 0.001). Decannulated children with high‐grade stenosis necessitated more endoscopic procedures (7.0 vs. 3.7, p = 0.02). Time to decannulation was similar between children with high‐ and low‐grade early postoperative stenosis (21.9 vs. 17.8 months, p = 0.63).ConclusionsHigher grade stenosis identified on the first airway endoscopy after suprastomal stent removal is correlated with lower decannulation rates and more postoperative endoscopic interventions. Although time to decannulation was not impacted by early stenosis grade, surgeons might utilize these early airway findings to counsel families and prognosticate possible surgical success.Level of Evidence4 Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 45%

Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical Outcomes by Early Airway Endoscopy Findings after Pediatric Staged Laryngotracheoplasty

et al. 2023

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Decannulation in Revision Pediatric Laryngotracheal Reconstruction

Leonard,

Blumenthal,

Behzadpour

et al. 2023

The Laryngoscope

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ObjectivesTo evaluate how patient characteristics and surgical techniques influence the rate of and time to decannulation after pediatric revision laryngotracheal reconstruction.MethodsThe 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.ResultsThirty‐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).ConclusionWe 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.Level of Evidence4 Laryngoscope, 2023

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Recalcitrant Stenosis Following Pediatric LTR: Contributing Factors and Clinical Impact

Blumenthal,

Leonard,

Behzadpour

et al. 2024

Otolaryngol.--head neck surg.

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ObjectivesLaryngotracheal reconstruction (LTR) has revolutionized the management of pediatric subglottic stenosis (SGS). However, postoperative stenosis remains a difficult hurdle to overcome. Our goal is to determine the clinical impact of recalcitrant stenosis after LTR and the factors contributing to postoperative stenosis.Study DesignRetrospective review of 181 open LTR patients between 2008 and 2021.SettingStand‐alone tertiary children's hospital.MethodsRecalcitrant stenosis was defined as new or worsening stenosis despite open LTR. Fisher's exact and Mann‐Whitney tests were used to detect differences in categorical and continuous clinical data between patients with and without treatment‐resistant stenosis. Time‐to‐decannulation analysis of both groups was performed using Kaplan‐Meier analysis and evaluated with log‐rank and Cox proportional hazards regression. Multivariate logistical regression was used to assess the validity of associations found in univariate analysis.ResultsAs expected, the 27 patients with postoperative stenosis were less likely to be decannulated (P < .001, Fisher's Exact), more likely to require a postoperative tracheostomy (P < .001, Fisher's Exact) or revision LTR (P < .001, Fisher's Exact) and had prolonged time to decannulation (P < .001, Log‐rank). Children with Grade IV SGS (P = .004, Fisher's Exact), and those with longer suprastomal stent duration (P = .03, Fisher's Exact) were more likely to suffer from recalcitrant stenosis. Stent duration longer than 4 weeks (P = .01) contributed to refractory stenosis when controlling for all aforementioned variables using multivariable logistic regression. Interposition grafts had a protective effect (P = .005).ConclusionMaintaining suprastomal stents over 4 weeks after LTR increases the risk for postoperative stenosis and its sequelae.Level of Evidence4

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Barriers to Decannulation After Double‐Stage Laryngotracheal Reconstruction

Cited by 6 publications

References 29 publications

Surgical Outcomes by Early Airway Endoscopy Findings after Pediatric Staged Laryngotracheoplasty

Surgical Outcomes by Early Airway Endoscopy Findings after Pediatric Staged Laryngotracheoplasty

Decannulation in Revision Pediatric Laryngotracheal Reconstruction

Recalcitrant Stenosis Following Pediatric LTR: Contributing Factors and Clinical Impact

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