Multidisciplinary aerodigestive team meetings for the management of complex airway patients

Objective

To examine the clinical profiles and management of patients discussed at our tertiary paediatric hospital's multidisciplinary aerodigestive team (ADT) meetings.

Method

Retrospective chart review of all patients discussed at the Perth Children's Hospital ADT meetings between December 2018 and July 2022. Patient demographics, clinical characteristics and meeting outcomes, including procedures, investigations and follow-up were reviewed.

Results

A total of 580 ADT meeting consults were recorded for 304 patients, with 116 patients requiring multiple consultations. The median age at time of consult was 2.74 years and 51.0 % of patients were male. The commonest aerodigestive tract disorders included tracheomalacia (20.7 %), laryngomalacia (20.7 %), laryngotracheal stenosis (13.2 %), gastro-oesophageal reflux (9.4 %) and tracheo-oesophageal fistula (9.4 %). A secondary diagnosis was seen in 45.5 % of patients, most commonly Trisomy 21 (10.2 %), Robin Sequence (4.9 %) and Cerebral Palsy (3.0 %). Children with secondary diagnoses (P < 0.01), tracheostomy dependence (P < 0.01), upper airway disorders (P < 0.01) and oesophageal disorders (P < 0.01) were more likely to require multiple ADT consults. Further investigations were ordered after 25.9 % of consults, most commonly polysomnography (14.9 %) and video fluoroscopic swallowing studies (6.1 %). A total of 742 procedures were performed to diagnose and/or treat aerodigestive disease. The commonest diagnostic procedures were microlaryngoscopy and bronchoscopy (46.9 %), upper gastrointestinal endoscopy (7.8 %) and sleep nasendoscopy (6.7 %). The commonest interventional surgical procedures were adenoidectomy (12.4 %), balloon dilation of laryngotracheal stenosis (9.4 %), steroid injection to laryngeal scar or granulation tissue (8.4 %) and supraglottoplasty (6.7 %).

Conclusion

The aerodigestive program utilises a multidisciplinary approach to manage a medically complex cohort of patients. This study presents a large sample of patients from an Otolaryngology-led aerodigestive program in Australia and is intended to guide development of aerodigestive programs across the world in various clinical contexts.