Carbon dioxide laser versus cold-steel supraglottoplasty: A comparison of post-operative outcomes.

Autor: Yeung JC; Department of Otolaryngology - Head & Neck Surgery, McGill University, Canada; Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, USA. Electronic address: jeffrey.yeung@mcgill.ca., Ali SO; Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, USA., McKeon MG; Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, USA., Grenier S; Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, USA., Kawai K; Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, USA., Rahbar R; Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, USA; Department of Otology and Laryngology, Harvard Medical School, USA., Watters KF; Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, USA; Department of Otology and Laryngology, Harvard Medical School, USA.
Jazyk: angličtina
Zdroj: International journal of pediatric otorhinolaryngology [Int J Pediatr Otorhinolaryngol] 2020 Mar; Vol. 130, pp. 109843. Date of Electronic Publication: 2019 Dec 24.
DOI: 10.1016/j.ijporl.2019.109843
Abstrakt: Objective: Supraglottoplasty is the mainstay of surgical treatment for laryngomalacia, and is commonly performed via two methods: cold steel or carbon dioxide (CO 2 ) laser. The degree of post-operative monitoring following supraglottoplasty varies, both within and between institutions. The aim of this study was to compare the post-operative monitoring and interventions required by patients undergoing cold-steel versus CO 2 laser supraglottoplasty.
Design: Retrospective cohort of pediatric patients (age < 18 years) undergoing supraglottoplasty at a tertiary care pediatric hospital. The primary exposure was the surgical instrument(s) used during supraglottoplasty. The primary outcome was prolonged intensive care unit (ICU)-stay (defined as >24 h).
Results: 155 cases were eligible for inclusion. Fifty-eight (37.4%) patients had a comorbid condition. Common indications for surgery included feeding difficulty (56.1%), severe respiratory distress (33.5%), and obstructive sleep apnea (25.2%). CO 2 laser was employed in 49 cases and cold-steel in 106 cases. Prolonged ICU-stay (>24 h) was observed in 14 CO 2 laser cases (28.6%) and 11 cold-steel cases (10.4%) (adjusted OR 3.42; 95% CI 1.43, 8.33). CO 2 laser cases were more likely to require post-operative intubation, non-invasive positive pressure ventilation, and nebulized racemic epinephrine. Concomitant neurological condition was associated with an increased risk of prolonged ICU-stay, while extent of surgery and age were not.
Conclusions: CO 2 laser supraglottoplasty is associated with an increased risk of prolonged ICU-stay and need for ICU-level airway intervention, compared to the cold-steel technique. While this association should not be misconstrued as a causal relationship, the current study demonstrates that specific surgical factors may influence the patient monitoring requirements following supraglottoplasty, particularly the choice of instrument and the extent of surgery.
Competing Interests: Declaration of competing interest None.
(Copyright © 2019 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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