Recalcitrant Stenosis Following Pediatric LTR: Contributing Factors and Clinical Impact
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2024
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| author | Daniel Blumenthal James A. Leonard Hengameh Behzadpour George Zalzal Diego Preciado |
| author_facet | Daniel Blumenthal James A. Leonard Hengameh Behzadpour George Zalzal Diego Preciado Daniel Blumenthal James A. Leonard Hengameh Behzadpour George Zalzal Diego Preciado |
| collection | Wiley Open Access |
| contents | Recalcitrant Stenosis Following Pediatric LTR: Contributing Factors and Clinical Impact Daniel Blumenthal James A. Leonard Hengameh Behzadpour George Zalzal Diego Preciado Otolaryngology–Head and Neck Surgery AbstractObjectivesLaryngotracheal 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 DesignRetrospective review of 181 open LTR patients between 2008 and 2021.SettingStand‐alone tertiary children's hospital.MethodsRecalcitrant 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.ResultsAs 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).ConclusionMaintaining suprastomal stents over 4 weeks after LTR increases the risk for postoperative stenosis and its sequelae.Level of Evidence4 10.1002/ohn.696 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1002/ohn.696 |
| format | Artículo Open Access |
| id | wiley_oa_10_1002_ohn_696 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2024 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Recalcitrant Stenosis Following Pediatric LTR: Contributing Factors and Clinical Impact Daniel Blumenthal James A. Leonard Hengameh Behzadpour George Zalzal Diego Preciado Otolaryngology–Head and Neck Surgery Recalcitrant Stenosis Following Pediatric LTR: Contributing Factors and Clinical Impact Daniel Blumenthal James A. Leonard Hengameh Behzadpour George Zalzal Diego Preciado Otolaryngology–Head and Neck Surgery AbstractObjectivesLaryngotracheal 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 DesignRetrospective review of 181 open LTR patients between 2008 and 2021.SettingStand‐alone tertiary children's hospital.MethodsRecalcitrant 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.ResultsAs 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).ConclusionMaintaining suprastomal stents over 4 weeks after LTR increases the risk for postoperative stenosis and its sequelae.Level of Evidence4 10.1002/ohn.696 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | Recalcitrant Stenosis Following Pediatric LTR: Contributing Factors and Clinical Impact |
| topic | Otolaryngology–Head and Neck Surgery |
| url | https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1002/ohn.696 |