Outcomes Following Single-Stage Laryngotracheal Reconstruction Using a "No Look" Extubation Philosophy

Abstract

Objective: This study aims to examine outcomes following single-stage laryngotracheal reconstruction (SSLTR) using a "no look" philosophy.

Study design: Case series with chart review.

Setting: Two urban, tertiary, children's hospitals.

Methods: Patients underwent primary or revision open SSLTR by 1 of 3 surgeons at 2 institutions. After a period of planned postoperative intubation, patients were extubated in the pediatric intensive care unit (PICU), with operative inspection of the airway deferred for 6 weeks unless symptoms of stridor or distress developed postoperatively. Short-term and long-term clinical outcome metrics were examined.

Results: From 2011 to 2021, 47 consecutive SSLTRs were completed, following which patients were extubated in the PICU without antecedent inspection of the airway. The mean age was 30.8 months (range: 3-130 months), and the mean preoperative stenosis grade was 2.1. There were 17 anterior grafts, 1 isolated posterior graft, and 29 A/P graft procedures; 19% of surgeries were revisions of prior open procedures. The mean PICU and hospital length of stay were 10.1 and 12.5 days, respectively. The failure rate following extubation was 4% (0% primary and 22% revision, P < .003), and 23% of patients had an unplanned return to the operating room for airway symptoms (21% primary and 33% revision, P = .44). Secondary endoscopic interventions were performed in 47% of cases; when required, the mean number of dilations was 2.2 (1.6 primary and 3.7 revision, P < .05). Long-term outcomes compared favorably with historical standards.

Conclusion: In select patients undergoing SSLTR, a "no look" philosophy may eliminate unnecessary surgical procedures without compromising short-term or long-term clinical outcomes.

Keywords: airway reconstruction; outcomes; pediatric; subglottic stenosis; tracheal reconstruction; tracheal stenosis.