Background

The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS-NSQIP-P) database monitors quality outcomes in pediatric surgery. However, the registry might underreport low-volume procedures. This review describes complications after laryngotracheal reconstruction (LTR) based on ACS-NSQIP-P reporting standards.

Methods

A case series with chart review at a tertiary children's hospital included consecutive LTR procedures between 2010 and 2018. Surgical procedures were grouped into single- or double-stage for comparison of thirty-day complication rates.

Results

Eighty-four procedures were reviewed with 70% (59/84) double-stage and 30% (25/84) single-stage. Children requiring double-stage procedures were younger (3.3 vs. 6.0 years, P = .002) and more often Black or African American (51% vs. 24%, P = .03). Double-stage LTR was frequently performed on children with grade 3 or 4 subglottic stenosis (90% vs. 52%, P < 001), with a tracheostomy (97% vs. 68%, P = .001) and with gastroesophageal reflux disease (93% vs. 67%, P = .004). Airway-related complications occurred in 19% (16/84) of children and non-airway complications occurred in 16% (13/84) with similar rates between groups. Unplanned reintubation (20% vs. 0%, P = .002), ventilator support longer than 48 hours (12% vs. 0%, P = .02), and total hospitalization lengths (15.6 vs. 6.5 days, P < .001) were increased after single-stage LTR. Children with non-airway complications had more central nervous system disorders (46% vs. 10%, P = .004).

Conclusion

Postoperative complications after pediatric LTR occur in nearly 20% of children and single-stage procedures have higher unplanned reintubations, prolonged ventilator support and hospitalization lengths. Surgeons should recognize that these typically minor events should be consistently monitored and reported after surgical expansion of the pediatric airway.

Level of evidence: IV

中文翻译：

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根据 ACS-NSQIP-P 报告评估小儿喉气管重建手术后的围手术期结果

背景

美国外科学院国家外科质量改进计划-儿科 (ACS-NSQIP-P) 数据库监测儿科手术的质量结果。但是，注册表可能会少报少量程序。本综述描述了基于 ACS-NSQIP-P 报告标准的喉气管重建 (LTR) 后的并发症。

方法

在一家三级儿童医院进行图表审查的病例系列包括 2010 年至 2018 年之间的连续 LTR 手术。手术手术分为单阶段或双阶段，以比较 30 天的并发症发生率。

结果

审查了 84 个程序，其中 70% (59/84) 双阶段和 30% (25/84) 单阶段。需要双阶段手术的儿童年龄较小（3.3 岁对 6.0 岁，P  = .002），黑人或非裔美国人更常见（51% 对 24%，P  = .03）。双期 LTR 常用于 3 级或 4 级声门下狭窄（90% 对 52%，P < 001）、气管切开术（97% 对 68%，P  = 0.001）和胃食管反流病的儿童（93% 对 67%，P  = .004）。19% (16/84) 的儿童发生气道相关并发症，16% (13/84) 发生非气道并发症，两组发生率相似。计划外再插管（20% vs. 0%，P = .002）、呼吸机支持时间超过 48 小时（12% 对 0%，P  = .02）和总住院时间（15.6 对 6.5 天，P  < .001）在单阶段 LTR 后增加。患有非气道并发症的儿童有更多的中枢神经系统疾病（46% 对 10%，P  = .004）。

结论

近 20% 的儿童发生儿科 LTR 后的术后并发症，单阶段手术具有更高的计划外再插管、更长的呼吸机支持和住院时间。外科医生应该认识到，这些典型的轻微事件应该在儿科气道手术扩张后持续监测和报告。

证据等级： IV