Recalcitrant Stenosis Following Pediatric LTR: Contributing Factors and Clinical Impact.

Autor: Blumenthal D; Department of Pediatric Otolaryngology, Children's National Hospital, Washington, USA.; Department of Otolaryngology-Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, USA., Leonard JA; Department of Pediatric Otolaryngology, Children's National Hospital, Washington, USA.; Department of Otolaryngology-Head and Neck Surgery, Medstar Georgetown University Hospital, Washington, USA., Behzadpour H; Department of Pediatric Otolaryngology, Children's National Hospital, Washington, USA., Zalzal G; Department of Pediatric Otolaryngology, Children's National Hospital, Washington, USA., Preciado D; Department of Pediatric Otolaryngology, Children's National Hospital, Washington, USA.; George Washington University School of Medicine, Washington, USA.
Jazyk: angličtina
Zdroj: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery [Otolaryngol Head Neck Surg] 2024 Jul; Vol. 171 (1), pp. 247-253. Date of Electronic Publication: 2024 Mar 14.
DOI: 10.1002/ohn.696
Abstrakt: Objectives: Laryngotracheal 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 Design: Retrospective review of 181 open LTR patients between 2008 and 2021.
Setting: Stand-alone tertiary children's hospital.
Methods: Recalcitrant 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.
Results: As 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).
Conclusion: Maintaining suprastomal stents over 4 weeks after LTR increases the risk for postoperative stenosis and its sequelae.
(© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)
Databáze: MEDLINE
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