Hybrid laryngotracheal reconstruction vs single and double stage: Indications and outcomes

Matthew P Partain; Gillian R Diercks; Nora Horick; Christopher J Hartnick

doi:10.1016/j.ijporl.2021.110948

Hybrid laryngotracheal reconstruction vs single and double stage: Indications and outcomes

Int J Pediatr Otorhinolaryngol. 2021 Dec:151:110948. doi: 10.1016/j.ijporl.2021.110948. Epub 2021 Oct 28.

Authors

Matthew P Partain¹, Gillian R Diercks², Nora Horick³, Christopher J Hartnick⁴

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
² Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
³ Divisision of Clinical Research - Massachusetts General Hospital, Boston, MA, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Pediatric Airway, Voice and Swallowing Center, Massachusetts General Hospital for Children, Boston, MA, USA. Electronic address: Christopher_Hartnick@meei.harvard.edu.

PMID: 34736009
DOI: 10.1016/j.ijporl.2021.110948

Abstract

Objectives: To describe outcomes from laryngotracheal reconstruction and decannulation rates for patients undergoing single stage, double stage and hybrid staged procedures at a single tertiary care institution and evaluate if the 1.5LTR is a viable reconstructive option for patients with subglottic stenosis.

Study design: Retrospective chart review.

Setting: Tertiary care otolaryngology specialty hospital and internationally.

Subjects: All patients who underwent LTR by a single pediatric otolaryngology surgeon from 2008 to 2018.

Methods: Charts were assessed for age, gender, etiology, type of reconstruction, comorbidities, length of stay, tracheostomy status and socioeconomic status. Analysis was performed using Microsoft Excel and multivariate logistic regression models.

Results: 96 patients underwent laryngotracheal reconstruction at MEEI. Internationally, 36 patients underwent laryngotracheal reconstruction with the primary surgeon. Overall decannulation rates for ssLTR, dsLTR, and 1.5LTR were 95.6%, 77.8%, and 91.2% respectively. Our Operation Specific Decannulation Rates (one open airway procedure only) for ssLTR, dsLTR, and 1.5LTR were 87.5%, 33%, and 88% respectively. Adjusted odds of decannulation were not significantly different between males and females, white and non-white patients, or socioeconomic status. Neurological comorbidity was statistically significant for a decreased rate of decannulation (p = 0.0216).

Conclusion: The 1.5LTR is a viable option for airway reconstruction with strengths derived from both the ssLTR and dsLTR. At our institution we have seen decannulation rates and operation specific decannulation rates with the 1.5LTR approaching our ssLTR. It has replaced the bulk of our dsLTRs, which we reserve for patients that have significant neurological deficits and cannot tolerate extended sedation.

Level of evidence: 4.

Keywords: Airway reconstruction; Pediatric airway; Pediatric airway (non-sleep).

MeSH terms

Comorbidity
Female
Humans
Laryngostenosis* / surgery
Male
Plastic Surgery Procedures*
Retrospective Studies
Tracheal Stenosis* / surgery
Treatment Outcome