ASPO084 - Trends in Natural Decannulation in Patients with Robin Sequence: A Twenty-five Year Retrospective Review
Sunday, May 1, 2022
11:20 AM – 12:00 PM CT
Location: Landmark C
Hari N. Magge, BA1, Nina M. Afsar, BA1, Esperanza Mantilla Rivas, MD2, Md Sohel Rana, MBBS3, Hengameh K. Behzadopour, MSHS4, Monica Manrique, MD2, Evie C. Landry, MD4, Albert K. Oh, MD2, Brian K. Reilly, MD4;
1George Washington Univ. Sch. of Med. and Hlth. Sci., Washington, DC, 2Division of Plastic and Reconstructive Surgery, Children's Natl. Hosp., Washington, DC, 3Division of Surgery, Children's Natl. Hosp., Washington, DC, 4Division of Otolaryngology - Head and Neck Surgery, Children's Natl. Hosp., Washington, DC.
Pediatric Otolaryngology Fellow Children's National Hospital
Introduction: Robin sequence (RS) is defined by micrognathia and glossoptosis that result in upper airway obstruction (UAO). In RS patients who undergo tracheostomy, long-term goals include decannulation without further surgical intervention (natural decannulation). The objective of this study was to identify long-term trends in rate and length of time to natural decannulation.
Methods: A retrospective chart review was performed on 151 RS patients treated at a large pediatric tertiary center from 1995 to 2020. Patients with UAO treated with tracheostomy were grouped by year of tracheostomy: 1995-2004, 2005-2014, and 2015-2020. Demographic data, UAO management, postoperative care, complications, and time to decannulation were recorded.
Results: Thirty-six patients (n=36) met the inclusion criteria (50% syndromic RS). Median UAO treatment age was 9.5 days [0 to 571 days of age]. 53% (n=19) of patients were naturally decannulated. Median time to decannulation was 12.3 years. Syndromic RS had significantly longer median time to decannulation (13.3 years vs. 3.2 years; p= 0.005). Natural decannulation rate was higher in the non-syndromic RS patients (78% vs. 28%; p= 0.003) and during the first study period (1995-2004: 73%, 2005-2014: 36%, and 2015-2020: 43%; p<0.05). Pre-operative capillary blood gas max-CO2 was higher in patients with syndromic RS (80 mEq/L vs. 67 mEq/L; p= 0.036). Univariate and multivariate regression analyses failed to demonstrate significant factors that inhibited getting decannulated. The rate of tracheostomy-specific complications was 54%, with an overall mortality rate of 3%.
Conclusion: Syndromic RS and higher pre-op max-CO2 were associated with long-term tracheostomy dependency. Decannulation rates were higher in the 1995-2004 patient subgroup, likely because tracheostomy is now only used in the most severe cases at our institution and mandibular distraction osteogenesis has become accepted primary surgical treatment in severe RS upper airway obstruction.