Risk stratification in endoscopic airway surgery: is inpatient observation necessary?

Am J Otolaryngol. 2014 Nov-Dec;35(6):747-52. doi: 10.1016/j.amjoto.2014.06.014. Epub 2014 Jul 10.

Abstract

Purpose: To compare post-operative complication rates between inpatient and outpatient endoscopic airway surgery in patients with laryngotracheal stenosis. Secondary objectives included characterization of a cohort of patients with this disease.

Methods: Retrospective review of patients with laryngotracheal stenosis in a tertiary care laryngology practice over a 5-year period.

Results: Ninety-one patients underwent 223 endoscopic airway surgeries. Of 114 outpatient interventions, 1 patient (0.8%) sought emergent medical care following discharge for respiratory distress. Of 109 procedures resulting in admission, no patients required transfer to a higher level of care, endotracheal intubation or placement of a surgical airway. There was no statistically significant difference in complication rates between patients treated as outpatients or inpatients (p=0.33, chi square). There were no cardiopulmonary events. There were no pneumothoraces despite frequent use of jet ventilation. The most common etiologic category was idiopathic (58%), followed by granulomatosis with polyangiitis (16%) and history of tracheotomy (12%). Most patients with idiopathic disease were female (p<0.001, Fisher's exact test).

Conclusion: Patients undergoing endoscopic surgery for airway stenosis rarely have post-operative complications, and outpatient surgery appears to be a safe alternative to post-operative admission and observation.

MeSH terms

  • Adult
  • Ambulatory Surgical Procedures*
  • Endoscopy* / adverse effects
  • Female
  • Hospitalization
  • Humans
  • Laryngostenosis / surgery*
  • Male
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Risk Assessment
  • Tracheal Stenosis / surgery*