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Supraglottoplasty for severe laryngomalacia can be effective and safe also in children with high-risk comorbidities - Experience from a tertiary center.
Medin, Gabriel; Wendt, Malin; Ekborn, Andreas; Andersson, Andreas; Gahm, Caroline.
Afiliación
  • Medin G; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
  • Wendt M; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.
  • Ekborn A; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Head Neck, Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden.
  • Andersson A; Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
  • Gahm C; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Head Neck, Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden. Electronic address: caroline.gahm@regionstockholm.se.
Int J Pediatr Otorhinolaryngol ; 171: 111632, 2023 Aug.
Article en En | MEDLINE | ID: mdl-37352590
ABSTRACT

OBJECTIVES:

Supraglottoplasty (SGP) for severe laryngomalacia (LM) in children with medical comorbidities has been associated with high risk of surgical failure and increased need of postoperative pediatric intensive care unit (PICU) intervention, but evidence for this is ambiguous. The objective was to evaluate surgical outcome and risk of need for PICU-intervention following SGP for severe LM in comorbid patients.

METHODS:

Retrospective observational study of 116 patients treated with SGP for severe LM between 2000 and 2021 at a tertial referral pediatric airway surgery center Karolinska University Hospital. Medical records were reviewed and patient data regarding surgical timing, type of SGP procedure, PICU-intervention, complications, and outcomes were recorded. Patients were defined as non-comorbid vs high-risk comorbid (HRC) based on a coexisting comorbidity for risk of surgical failure and postoperative PICU-intervention. Surgical failure was defined as need of revision surgery, tracheostomy or assisted ventilation (continuous positive airway pressure and bilevel positive airway pressure). PICU intervention was defined as need of postoperative assisted ventilation or intubation. Statistical comparisons were performed with outcome of SGP on children with LM and no comorbidities.

RESULTS:

41/116 patients included had a HRC associated with an increased risk of PICU-intervention and surgical failure. 75/116 patients were defined as non-comorbid. The overall surgical success in the study population was 89.7% (104/116), 94.7% in the non HRC group vs 80.5% in the HRC-group. 5/41 HRC patients and 1/75 non-comorbid patients needed SGP revision in which 5/6 was successful. There was no significantly increased need for postoperative PICU intervention in HRC patients.

CONCLUSION:

SGP for severe LM patients with high-risk comorbidities performed in a tertiary setting had an overall good result and low risk of PICU-intervention. Revision SGP was more common in HRC patients but had a good outcome. Multidisciplinary experience in perioperative care of comorbid patients may be of key importance for outcome and children with high-risk comorbidities should thus not be withheld the possible benefit of SGP without assessment at a tertiary pediatric airway center.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Laringomalacia Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Child / Humans / Infant Idioma: En Revista: Int J Pediatr Otorhinolaryngol Año: 2023 Tipo del documento: Article País de afiliación: Suecia

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Laringomalacia Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Child / Humans / Infant Idioma: En Revista: Int J Pediatr Otorhinolaryngol Año: 2023 Tipo del documento: Article País de afiliación: Suecia