ASPO088 - The Value of Routine Intensive Care Monitoring After Pediatric Endoscopic Airway Surgeries
Sunday, May 1, 2022
11:20 AM – 12:00 PM CT
Location: Landmark C
Waleed Alshareef, Saudi Board of ORL-HNS, Bshair Aldriweesh, Saudi Board of ORL-HNS, Abdulmajeed Zakzouk, Consultant Pediatric ORL and Airway Surgery, Abdullah Aljasser, Consultant Pediatric ORL and Airway Surgery, Ahmad Alammar, Consultant Pediatric ORL and Airway Surgery
Introduction: Endoscopic airway surgery (EAS) indications expanded and became widely used among airway surgeons. Although EAS are considered less invasive procedures it still carries a significant risk for postoperative airway edema with the possible need for an urgent airway intervention. Previous studies reported that majority of respiratory adverse events following certain types of EAS occurred within hours after surgery. The primary focus of this study is to assess the need for ICU care after various EAS by recording all postoperative respiratory adverse events happened within 24-hours of surgery.
Methods: A retrospective charts review of pediatric patients below the age of 18 years who underwent EAS at a tertiary care academic center between 2015 and 2021. Demographics, endoscopic interventions, postoperative disposition, and early postoperative events within 24-hours of surgery were recorded and analyzed.
Results: Ninety-nine surgical procedures for 38 patients were included. The age at the time of intervention ranged from 8 months to 18 years. Eleven patients (11.1%) had a comorbid condition, and 4 patients (4%) were syndromic. Variety of endoscopic airway interventions were performed including papilloma debulking (58.6%) and Balloon dilation (25.3%). The remaining patients (20.1%) underwent supraglottoplasty, partial arytenoidectomy, glottic web release, laryngeal cyst marsupialization, epiglottopexy and/or laryngeal cleft repair. Early postoperative respiratory events were encountered in 16 patients (16%). The majority (75 %) of these events manifested within 4 hours after surgery. Supportive management was sufficient in most patients while 5 patients ultimately required intubation. The mean operative duration of those who developed post-operative respiratory events was significantly higher (P-value, 0.045, mean difference, 17.16 minutes).
Conclusion: The majority of serious adverse events following EAS manifest shortly after surgery. A short period of airway observation in step-down or high dependency unit following EAS is expected to result in better hospital resources utilization. Prolonged procedure duration increases the risk of adverse postoperative events.