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Pediatric Otolaryngology

Factors Contributing to Restenosis Following Laryngotracheal Reconstruction

Sunday, October 1, 2023
5:48 PM - 5:54 PM East Coast USA Time
Location: 207CD

    Presenting Author(s)

  • Daniel L. Blumenthal, MD

    Resident Physician
    Georgetown University Hospital
    Washington, DC, United States

    • Co-Author(s)

  • JL

    James A. Leonard, MD

    Resident Physician
    Georgetown University Hospital
    Washington, DC, United States

  • AH

    Andy Habib, MPH

    Georgetown University School of Medicine, USA

  • George H. Zalzal, MD

    professor and Chief Emeritus, Pediatric Otolaryngology
    Children's National Medl Ctr Dept of OTO
    Washington , DC, United States

    • Senior Author(s)

  • DP

    Diego A. Preciado, MD, PHD

    Chief of Otolaryngology
    Department of Otolaryngology–Head & Neck Surgery, George Washington University, Children's National Hospital, Washington, DC, USA; Editorial Board JAMA Otolaryngol Head Neck Surg
    Washington, DC, United States

Disclosure(s):
Daniel L. Blumenthal, MD: No relevant relationships to disclose.
James A. Leonard, MD: No relevant relationships to disclose.
Introduction: Laryngotracheal Reconstruction (LTR) has revolutionized the management of infants and children with subglottic stenosis, however, postoperative restenosis remains a difficult hurdle to overcome. This review aims to determine preoperative, operative and postoperative factors contributing to restenosis following LTR.

Methods: We identified 168 patients treated at a stand-alone tertiary children’s hospital who underwent open airway reconstruction from 2008 to 2021. Fisher’s exact and Mann-Whitney tests were used to detect differences in categorical and continuous clinical data respectfully. Time to decannulation analysis was performed using Kaplan Meier analysis and evaluated with log-rank and Cox proportional hazards regression

Results: Children with a pre-existing tracheostomies were more likely to develop restenosis following LTR tracheostomy (P = .029, Fisher’s Exact). Patients undergoing staged reconstruction (P = .0001, Fisher’s Exact), those with a postoperative stent (P = .0006, Fisher’s Exact) and longer duration with a stent (P = .0085, Mann-Whitney) were also more likely to develop restenosis. Patients with restenosis were less likely to be decannulated (P = .0006, Fisher’s Exact), more likely to require a revision tracheostomy (P = .0105, Fisher’s Exact) and or revision LTR (P < .0001, Fisher’s Exact) and had prolonged time to decannulation (P < .0001, Log-rank).

Conclusions: Pre-existing tracheostomy, staged reconstruction and postoperative stent use are all associated with postoperative restenosis; which leads to significant morbidity following LTR