Outcomes of laryngeal surgery in children with congenital laryngomalacia and neurological and neurodevelopmental comorbidities - A NSQIP analysis

Abstract

Introduction

Children with neurological and neurodevelopmental comorbidities (NNC) may experience poorer post-operative outcomes following the surgical management of laryngomalacia. The objective of this study is to assess short-term outcomes of this group.

Methods

A retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program – Pediatric Database years 2015–2023. Pediatric patients ages 18 and under were selected by CPT codes 31541 and 31561 and ICD-10 code Q31.5. NNC were defined as the presence of impaired cognitive status/developmental delay, seizure disorder, cerebral palsy, structural central nervous system abnormality, or neuromuscular disorder.

Results

A total of 5805 cases met the inclusion criteria, with 1229 cases involving patients with NNC. Patients with NNC were older at the time of surgery (14.7 vs. 4.1 months; p < 0.001), more frequently classified as American Society of Anesthesiologists class 3 (71 % vs. 46 %, p < 0.001), more likely to have cardiac risk factors (38.7 % vs. 13.2 %; p < 0.001) and to be born prematurely (31.5 % vs. 18.4 %; p < 0.001).

While controlling for sociodemographic and medical factors, children with NNC were at 2.85 times greater odds of developing post-operative pneumonia (95 % CI 1.36–6.01, p = 0.005), 2.35 times greater odds of requiring oxygen at discharge (95 % CI 1.61–3.44, p < 0.001), and 1.90 times greater odds of undergoing unplanned reintubation (95 % CI 1.04–3.45, p = 0.036).

Conclusion

Patients with NNC undergoing laryngeal surgery for laryngomalacia may be at a higher risk of postoperative complications, highlighting the importance of careful evaluation of surgical management and postoperative monitoring in this population.