Resident Physician MedStar Georgetown University Hospital MedStar Georgetown University Hospital, District of Columbia
Introduction: Laryngotracheal stenosis can be a devastating diagnosis causing respiratory insufficiency and requiring surgical intervention. Management of tracheal stenosis, representing 0.3-1% of laryngotracheal stenosis, was revolutionized by introduction of the Slide Tracheoplasy. The goal of this investigation was to identify factors predicting success in slide tracheoplasty at a regional children’s hospital and compare with available literature.
Methods: A retrospective chart review was performed analyzing outcomes of slide tracheoplasty at a large, academic, tertiary care facility over nearly a decade. These results were compared with published literature through a systematic review.
Results: 17 patients were identified with tracheal stenosis who underwent slide tracheoplasty. The mean age and weight were 5.2 months and 5.04 kg, respectively. Length of stay on average 29.1 days in the ICU and 33.1 days in hospital. Tracheostomy was required for 5 patients and no early deaths were reported. 565 children were grouped in the systematic review. Similar length of stays were identified with a mean of 28.52 days in the ICU and 39.31 days overall. Mortality etiology for 62 patients was reported: 22 (35.5%) cardiac-related and 36 (58%) late mortalities. Our overall calculated mortality risk of 1.50 (P <0.05) was lower than reported ratios of 2.0+.
Conclusion: A rare clinical entity, surgical management of tracheal stenosis remains challenging despite many advancements. Mortality was dramatically improved with introduction of the slide tracheoplasty but not eliminated. Further studies are needed to evaluate correlations between presentation characteristics and mortality.