Identifying Predictors of Revision Supraglottoplasty

Introduction: Most cases of congenital laryngomalacia are self limiting with observation and/or reflux therapy. However, 15% of patients require a supraglottoplasty (SGP) for unrelenting moderate to severe symptoms. Although rare, revision SGP may be required for persistent or recurrent symptoms.

Methods: Retrospective cohort study of laryngomalacia patients from years 2004 to 2022 who underwent SGP at a centralized and only state tertiary referral pediatric hospital. Demographic, clinical and perioperative data were evaluated to identify predictors of revision surgery using univariate and multivariate logistic regression analysis.

Results: Out of 1220 patients, 94(8%) required revision SGP. Of revision patients, 65(83%) underwent revision with cold steel, 10(13%) underwent laser supraglottoplasty, and16 required a G-tube. There was no significant difference in medical comorbidities in patients requiring revision supraglottiplasty. On univariate analysis, preoperative dyspnea (OR: 1.8, CI: 1.2-2.7), presence of a g-tube (OR: 3.3, CI:1.9-5.9), tracheomalacia (OR:1.9, CI: 1.1-3.2), subglottic stenosis (OR: 4.5, CI 2.7-7.7) and laryngeal cleft (OR 2.8, CI:1.3-6.2) significantly increased the likelihood of revision SGP. Medical therapy significantly decreased likelihood of revision (OR 0.5, CI 0.3-0.9).

Conclusions: Revision SGP is necessary in 8% of children with moderate to severe laryngomalacia. Secondary airway lesions and severe dysphagia increase the likelihood of revision SGP while reflux therapy trends to protect against it,