Tracheotomy after Laryngotracheoplasty: Risk Factors over Ten Years

Background

Subglottic stenosis (SGS) is the most common congenital and/or acquired laryngotracheal anomaly requiring tracheotomy in infants. We sought to determine factors associated with a greater likelihood of tracheotomy in symptomatic infants with SGS who underwent laryngotracheoplasty (LTP).

Methods

Retrospective case series with chart review of patients undergoing single-stage LTP for SGS over a 10-year period (2001–2010) in a tertiary-care pediatric hospital.

Results

Twenty-two children (15 boys, 7 girls), with a mean gestational age of 32.5 weeks, underwent LTP with and without interpositional grafting, at a median age of 89 days. Ten patients (43%) required postoperative tracheotomy. Of patients weighing < 2.5 kg, 7 of 8 eventually required tracheotomy, while none weighing > 5 kg needed tracheotomy ( p = 0.003). The average length of stay for patients with a tracheotomy was 125 days, while those without tracheotomy required only 58 days ( p = 0.011). The grade of SGS ( p = 0.809), gender ( p = 0.968), age at surgery ( p = 0.178), and gestational age ( p = 0.117) were not significantly associated with the need for tracheotomy. Weight at surgery was significantly correlated with the likelihood of needing tracheotomy ( p = 0.003).

Conclusions

Patients who weighed less than 2.5 kg at the time of LTP procedures were more likely to require a postoperative tracheotomy. Children who required tracheotomy had longer lengths of hospital stay.