Outcomes of infant laryngotracheal reconstruction in tracheostomy decannulation and avoidance

Objective

Management of laryngotracheal stenosis in the infant is challenging for patients, families, and providers. This study was designed to evaluate the impact of patient characteristics and surgical techniques on rates of tracheostomy decannulation and avoidance in infants managed with laryngotracheal reconstruction (LTR).

Methods

Charts were retrospectively reviewed for all pediatric patients with laryngotracheal stenosis managed with open airway surgery at a tertiary children's hospital between 2008 and 2021. The primary outcome evaluated was tracheostomy decannulation and avoidance.

Results

Forty infants were included in the study with a median age of 7.5 months and weight of 6.7 kg. More than half (62.5 %) of the infants were Black or African American. Seventy percent of patients included had grade 3 Myer-Cotton subglottic stenosis. Infants, compared with children (n = 153), were far less likely to have a tracheostomy prior to LTR (22.5 % vs 73.2 %, p < 0.001), undergo double stage surgery (17.5 % vs 51 %, p = 0.001), or use stenting post operatively (7.5 % vs 34.6 %, p = 0.001). Rates of tracheostomy decannulation and avoidance in infants were similar to those in children treated with LTR (82.5 % vs 75.2 %, p = 0.404). In infants, the rate of tracheostomy decannulation and avoidance was far lower in those treated with double stage surgery (OR 0.075, CI 0.01–0.47, p = 0.008), with glottic stenosis (OR 0.103, CI 0.015–0.62, p = 0.015), or multilevel stenosis (OR 0.075, CI 0.01–0.47, p = 0.008).

Conclusion

We present a large cohort of infants undergoing LTR for tracheostomy decannulation and avoidance demonstrating efficacy with a reduced chance of success with glottic or multilevel stenosis.