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A comparative analysis of open surgery vs endoscopic balloon dilation for pediatric subglottic stenosis.
JAMA Otolaryngol Head Neck Surg 2014; 140(10):901-5JO

Abstract

IMPORTANCE

Minimally invasive endoscopic techniques are an appealing alternative to open surgical management of pediatric subglottic stenosis (SGS), but more information is needed to understand the comparative risks, benefits, and limitations of such interventions.

OBJECTIVE

To compare the effectiveness of endoscopic balloon dilation (EBD) and laryngotracheoplasty (LTP) in pediatric patients with SGS and to identify patient and disease factors that are associated with successful EBD.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective medical record review of children undergoing EBD and LTP for SGS in a tertiary care children's hospital from 2006 through 2012.

MAIN OUTCOMES AND MEASURES

Success was defined as decannulation or tracheotomy avoidance. Additional outcomes were total number of procedures and number of unplanned procedures. Univariate χ2 analyses and multivariate regression analyses were performed to identify patient and disease factors statistically associated with success within treatment groups.

RESULTS

Overall, 86 of 90 patients (96%) successfully avoided tracheotomy or were decannulated. Fourteen patients were successfully treated with EBD, but for 13 patients, EBD failed, and they underwent LTP. A total of 76 patients underwent LTP. In univariate analyses, patients for whom EBD was successful were more likely to have mild (grade 1 or 2; n = 10) than severe (grade 3 or 4; n = 4) SGS compared with patients for whom EBD failed (grade 1 or 2, n = 0 vs grade 3 or 4, n = 13) (P < .001). Three patients who underwent initial EBD had worsening stenosis. Patients initially treated with EBD were more likely to require unplanned surgical intervention during their treatment (6 of 27; 22%) than patients initially treated with LTP (3 of 63; 5%) (P = .01). Patients initially treated with EBD had a lower number of airway interventions and/or evaluations under anesthesia (mean, 6.7) during their course of treatment than patients initially treated with LTP (mean, 9.2) (P = .003). In multivariate analyses, only severe SGS was significantly associated with failure of initial EBD (13 of 13 [100%] with type 3 or 4 vs 4 of 14 with type 1 or 2 [29%]) (P = .002).

CONCLUSIONS AND RELEVANCE

For severe SGS, EBD has limited application compared with LTP, and in some cases failed EBD is even detrimental, increasing the risk of unplanned urgent interventions compared with LTP.

Authors+Show Affiliations

Division of Pediatric Otolaryngology, Children's National Medical Center, Washington, DC2Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York.Division of Pediatric Otolaryngology, Children's National Medical Center, Washington, DC.Drexel University College of Medicine, Philadelphia, Pennsylvania.Division of Pediatric Otolaryngology, Children's National Medical Center, Washington, DC.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25170960

Citation

Maresh, Alison, et al. "A Comparative Analysis of Open Surgery Vs Endoscopic Balloon Dilation for Pediatric Subglottic Stenosis." JAMA Otolaryngology-- Head & Neck Surgery, vol. 140, no. 10, 2014, pp. 901-5.
Maresh A, Preciado DA, O'Connell AP, et al. A comparative analysis of open surgery vs endoscopic balloon dilation for pediatric subglottic stenosis. JAMA Otolaryngol Head Neck Surg. 2014;140(10):901-5.
Maresh, A., Preciado, D. A., O'Connell, A. P., & Zalzal, G. H. (2014). A comparative analysis of open surgery vs endoscopic balloon dilation for pediatric subglottic stenosis. JAMA Otolaryngology-- Head & Neck Surgery, 140(10), pp. 901-5. doi:10.1001/jamaoto.2014.1742.
Maresh A, et al. A Comparative Analysis of Open Surgery Vs Endoscopic Balloon Dilation for Pediatric Subglottic Stenosis. JAMA Otolaryngol Head Neck Surg. 2014;140(10):901-5. PubMed PMID: 25170960.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparative analysis of open surgery vs endoscopic balloon dilation for pediatric subglottic stenosis. AU - Maresh,Alison, AU - Preciado,Diego A, AU - O'Connell,Ashley P, AU - Zalzal,George H, PY - 2014/8/30/entrez PY - 2014/8/30/pubmed PY - 2015/2/11/medline SP - 901 EP - 5 JF - JAMA otolaryngology-- head & neck surgery JO - JAMA Otolaryngol Head Neck Surg VL - 140 IS - 10 N2 - IMPORTANCE: Minimally invasive endoscopic techniques are an appealing alternative to open surgical management of pediatric subglottic stenosis (SGS), but more information is needed to understand the comparative risks, benefits, and limitations of such interventions. OBJECTIVE: To compare the effectiveness of endoscopic balloon dilation (EBD) and laryngotracheoplasty (LTP) in pediatric patients with SGS and to identify patient and disease factors that are associated with successful EBD. DESIGN, SETTING, AND PARTICIPANTS: A retrospective medical record review of children undergoing EBD and LTP for SGS in a tertiary care children's hospital from 2006 through 2012. MAIN OUTCOMES AND MEASURES: Success was defined as decannulation or tracheotomy avoidance. Additional outcomes were total number of procedures and number of unplanned procedures. Univariate χ2 analyses and multivariate regression analyses were performed to identify patient and disease factors statistically associated with success within treatment groups. RESULTS: Overall, 86 of 90 patients (96%) successfully avoided tracheotomy or were decannulated. Fourteen patients were successfully treated with EBD, but for 13 patients, EBD failed, and they underwent LTP. A total of 76 patients underwent LTP. In univariate analyses, patients for whom EBD was successful were more likely to have mild (grade 1 or 2; n = 10) than severe (grade 3 or 4; n = 4) SGS compared with patients for whom EBD failed (grade 1 or 2, n = 0 vs grade 3 or 4, n = 13) (P < .001). Three patients who underwent initial EBD had worsening stenosis. Patients initially treated with EBD were more likely to require unplanned surgical intervention during their treatment (6 of 27; 22%) than patients initially treated with LTP (3 of 63; 5%) (P = .01). Patients initially treated with EBD had a lower number of airway interventions and/or evaluations under anesthesia (mean, 6.7) during their course of treatment than patients initially treated with LTP (mean, 9.2) (P = .003). In multivariate analyses, only severe SGS was significantly associated with failure of initial EBD (13 of 13 [100%] with type 3 or 4 vs 4 of 14 with type 1 or 2 [29%]) (P = .002). CONCLUSIONS AND RELEVANCE: For severe SGS, EBD has limited application compared with LTP, and in some cases failed EBD is even detrimental, increasing the risk of unplanned urgent interventions compared with LTP. SN - 2168-619X UR - https://www.unboundmedicine.com/medline/citation/25170960/A_comparative_analysis_of_open_surgery_vs_endoscopic_balloon_dilation_for_pediatric_subglottic_stenosis_ L2 - https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2014.1742 DB - PRIME DP - Unbound Medicine ER -