Structured care to improve outcomes in primary single stage laryngotracheal reconstruction

Publication date: Available online 23 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Prasad John Thottam, Matthew Georg, Jeffrey P. Simons, Ryota Kashiwazaski, Deepak K. Mehta

Abstract

Purpose

To examine single stage laryngotracheal reconstruction (SSLTR) care to reduce complication and failure rate.

Methods

Forty-five patients that underwent primary SSLTR were examined retrospectively. All had pre-operative direct laryngoscopy and bronchoscopy, esophagoscopy with biopsy and MRSA screening. Pre-operative subglottic stenosis (SGS) grade and associated comorbidities were recorded. Intraoperative graft location and type was documented. Hospital course and results were evaluated and compared to cited literature.

Results

The median age at reconstruction was 2 years (0-15 years). 42.2% were male. 66.7% had gastroesophageal disease and 24.4% a MRSA history. Grade 2 SGS was noted pre-operatively in 37.8% and grade 3 or 4 in 57.7% of patients. Post-surgical hospital course was examined. 77.8% of patients were extubated on planned date. 95.6% of patients had operation specific successful decannulation. Graft type and variations of graft placement as well as MRSA and GERD status didn't affect procedure success rate. Active GERD was related to failure of extubation on planned day (p=0.02). An abnormal pre-operative swallowing examination was associated with higher complication rates (p=0.03).

Conclusion

Utilizing a more structured approach to SSLTR work-up and addressing potential SSLTR pitfalls may result in higher operation specific decannulation rates. Pre-operative GERD and swallowing dysfunction were associated with higher rates of adverse events.

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