Safety and postoperative adverse events in pediatric airway reconstruction: Analysis of ACS-NSQIP-P 30-day outcomes

2016 ◽  
Vol 127 (2) ◽  
pp. 504-508 ◽  
Author(s):  
Christopher R. Roxbury ◽  
Kris R. Jatana ◽  
Rahul K. Shah ◽  
Emily F. Boss
Keyword(s):  
Adverse Events ◽  
Pediatric Airway ◽  
Acs Nsqip ◽  
Airway Reconstruction

Bronchoscopy for Pediatric Airway Foreign Body: Thirty-Day Adverse Outcomes in the ACS NSQIP-P

2018 ◽  
Vol 160 (2) ◽  
pp. 326-331 ◽  
Author(s):  
Grace X. Tan ◽  
Emily F. Boss ◽  
Daniel S. Rhee
Keyword(s):  
Foreign Body ◽  
Postoperative Complications ◽  
Adverse Events ◽  
National Database ◽  
Improvement Program ◽  
Data Set ◽  
Pediatric Airway ◽  
Foreign Body Removal ◽  
Acs Nsqip ◽  
Public Data

Objectives (1) Describe outcomes of bronchoscopy with foreign body removal among children on the basis of a large standardized multi-institutional data set. (2) Identify factors associated with 30-day adverse events. Study Design Cross-sectional analysis of a US national database. Setting Public data set from the ACS NSQIP-P (American College of Surgeons National Surgical Quality Improvement Program–Pediatric) from 2012 to 2015. Subjects and Methods Children <18 years old who underwent bronchoscopy with removal of foreign body were identified. Patient demographics, comorbidities, hospitalization factors, surgical characteristics, and 30-day postoperative adverse events, including complication and readmission, were analyzed. Multivariate logistic regression identified predictive factors for postoperative complications and prolonged length of stay. Results A total of 275 children underwent bronchoscopic foreign body removal (n = 165 male, 60%; n = 75 nonwhite and/or Hispanic, 27%; mean age, 3.5 years [range, 0.63-17.9; median, 2.0]). Adverse events occurred among 10 children (4%). Seven had pulmonary-related complications, and 1 patient died. Three patients were readmitted; there were no reoperations. On multivariate analysis, preoperative pulmonary disease or need for pulmonary support (odds ratio [OR], 6.42; P = .04) predicted postoperative complications. Preoperative pulmonary compromise (OR, 8.10; P < .01), American Society of Anesthesiologists class 3 or 4 (OR, 4.13; P < .01), and prolonged operative time (OR, 3.05; P = .01) were associated with prolonged hospital stay. Conclusion Bronchoscopy for retrieval of foreign body among children has an overall low incidence of 30-day adverse events. Children with preoperative pulmonary compromise have a significantly higher risk of postoperative complications. These findings may be applied to optimize perioperative care and counsel parents and families.

Tracheocutaneous Fistula After Pediatric Open Airway Reconstruction

2021 ◽  
pp. 000348942098742
Author(s):  
Stephen R. Chorney ◽  
Joanne Stow ◽  
Luv R. Javia ◽  
Karen B. Zur ◽  
Ian N. Jacobs ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Case Series ◽  
Primary Objective ◽  
Multivariable Logistic Regression Analysis ◽  
Pediatric Airway ◽  
Surgical Closure ◽  
Laryngotracheal Reconstruction ◽  
Airway Reconstruction ◽  
Tracheocutaneous Fistula

Objectives: Tracheocutaneous fistula (TCF) is a common occurrence after pediatric tracheostomy decannulation. However, the persistence of TCF after staged reconstruction of the pediatric airway is not well-described. The primary objective was to determine the rate of persistent TCF after successful decannulation in children with staged open airway reconstruction. Methods: A case series with chart review of children who underwent decannulation after double-stage laryngotracheal reconstruction between 2017 and 2019. Results: A total of 26 children were included. The most common open airway procedure was anterior and posterior costal cartilage grafting (84.6%, 22/26). Median age at decannulation was 3.4 years (IQR: 2.8-4.3) and occurred 7.0 months (IQR: 4.3-10.4) after airway reconstruction. TCF persisted in 84.6% (22/26) of children while 15.4% (4/26) of stomas closed spontaneously. All closures were identified by the one-month follow-up visit. There was no difference in age at tracheostomy ( P = .86), age at decannulation ( P = .97), duration of tracheostomy ( P = .43), or gestational age ( P = .23) between stomas that persisted or closed. Median diameter of stent used at reconstruction was larger in TCFs that persisted (7.0 mm vs 6.5 mm, P = .03). Tracheostomy tube diameter ( P = .02) and stent size ( P < .01) correlated with persistence of TCF on multivariable logistic regression analysis. There were 16 surgical closure procedures, which occurred at a median of 14.4 months (IQR: 11.4-15.4) after decannulation. Techniques included 56.3% (9/16) by primary closure, 18.8% (3/16) by secondary intention and 25% (4/16) by cartilage tracheoplasty. The overall success of closure was 93.8% (15/16) at latest follow-up. Conclusions: Persistent TCF occurs in 85% of children who are successfully decannulated after staged open airway reconstruction. Spontaneous closure could be identified by 1 month after decannulation and was more likely when smaller stents and tracheostomy tubes were utilized. Surgeons should counsel families on the frequency of TCF and the potential for additional procedures needed for closure.

Stenting in pediatric airway reconstruction

2012 ◽  
Vol 122 (S4) ◽  
pp. S97-S98 ◽  
Author(s):  
Diego Preciado
Keyword(s):  
Pediatric Airway ◽  
Airway Reconstruction

Pediatric Airway Reconstruction at Great Ormond Street: A Ten-Year Review

1992 ◽  
Vol 101 (6) ◽  
pp. 465-468 ◽  
Author(s):  
James W. Ochi ◽  
John N. G. Evans ◽  
C. Martin Bailey
Keyword(s):  
Costal Cartilage ◽  
Laryngotracheal Stenosis ◽  
Pediatric Airway ◽  
Airway Reconstruction ◽  
Cartilage Grafting

One hundred eight consecutive patients with pediatric laryngotracheal stenosis requiring airway reconstruction over a 10-year period were reviewed. One hundred forty-nine operations consisting of 75 laryngotracheoplasties and 74 laryngotracheal reconstructions with costal cartilage grafting were performed. The Cotton grading scheme of preoperative stenosis was useful in predicting likelihood of decannulation. In all, 90 patients (83%) were decannulated.

1073: Adverse Events Before and After Pediatric Airway Emergency Response Team Activation

2020 ◽  
Vol 49 (1) ◽  
pp. 537-537
Author(s):  
Shakthi Jayanthy Venkatachalam ◽  
Annery Garcia-Marcinkiewicz ◽  
Rita Giordano ◽  
Joanne Stow ◽  
Janet Lioy ◽  
...  
Keyword(s):  
Adverse Events ◽  
Emergency Response ◽  
Pediatric Airway ◽  
Airway Emergency ◽  
Before And After ◽  
Response Team

SP364 – Feeding and growth after pediatric airway reconstruction

2009 ◽  
Vol 141 (3) ◽  
pp. P206-P206
Author(s):  
Steven Michael Andreoli ◽  
David R. White ◽  
Shaun A. Nguyen
Keyword(s):  
Pediatric Airway ◽  
Airway Reconstruction

A Sustainable and Scalable Multidisciplinary Airway Teaching Mission: The Operation Airway 10-Year Experience

2020 ◽  
Vol 163 (5) ◽  
pp. 971-978
Author(s):  
Asitha D. L. Jayawardena ◽  
Zelda J. Ghersin ◽  
Marcos Mirambeaux ◽  
Jose A. Bonilla ◽  
Ernesto Quiñones ◽  
...  
Keyword(s):  
Dominican Republic ◽  
El Salvador ◽  
Multidisciplinary Team ◽  
Surgical Outcomes ◽  
Demographic Data ◽  
Operative Procedure ◽  
Case Series ◽  
The United States ◽  
Pediatric Airway ◽  
Airway Reconstruction

Objective To address whether a multidisciplinary team of pediatric otolaryngologists, anesthesiologists, pediatric intensivists, speech-language pathologists, and nurses can achieve safe and sustainable surgical outcomes in low-resourced settings when conducting a pediatric airway surgical teaching mission that features a program of progressive autonomy. Study Design Consecutive case series with chart review. Setting This study reviews 14 consecutive missions from 2010 to 2019 in Ecuador, El Salvador, and the Dominican Republic. Methods Demographic data, diagnostic and operative details, and operative outcomes were collected. A country’s program met graduation criteria if its multidisciplinary team developed the ability to autonomously manage the preoperative huddle, operating room discussion and setup, operative procedure, and postoperative multidisciplinary pediatric intensive care unit and floor care decision making. This was assessed by direct observation and assessment of surgical outcomes. Results A total of 135 procedures were performed on 90 patients in Ecuador (n = 24), the Dominican Republic (n = 51), and El Salvador (n = 39). Five patients required transport to the United States to receive quaternary-level care. Thirty-six laryngotracheal reconstructions were completed: 6 single-stage, 12 one-and-a-half-stage, and 18 double-stage cases. We achieved a decannulation rate of 82%. Two programs (Ecuador and the Dominican Republic) met graduation criteria and have become self-sufficient. No mortalities were recorded. Conclusion This is the largest longitudinal description of an airway reconstruction teaching mission in low- and middle-income countries. Airway reconstruction can be safe and effective in low-resourced settings with a thoughtful multidisciplinary team led by local champions.

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