Outcome prediction of laryngotracheal reconstruction with costal graft in pediatric patients: Role of European Laryngological Society Score (ELS-SCORE)

Background:

Laryngotracheal reconstruction (LTR) with costal graft is the treatment of choice for intermediate-grade pediatric subglottic/glottic stenosis. However, some patients may require re-interventions or might experience delayed decannulation. We investigated risk factors for re-treatment and failure in decannulation.

Methods:

We included 52 patients (19 females, mean age 5.3 ± 4 years) affected by subglottic/glottic stenosis, treated by LTR with costal graft. Patients were stratified in two groups, according to ELS-Score (based on grade, extension of stenosis and comorbidities), into low-risk (LR, ELS-Score ≤IIIa) and high risk (HR, ELS-Score ≥IIIb). Prevalence of previous treatments, comorbidities, age, post-operative complications, number and need for additional treatment and decannulation were tested in the two subgroups.

Results:

Patients with HR were significantly younger than those with LR (age 4.1 ± 3 vs. 7 ± 4.6 years old, p < 0.01). HR had more comorbidities (p < 0.01).

Decannulation rate was higher in LR compared to HR (95% vs. 69%, p < 0.05).

Patients in the HR had a significantly longer interval between surgery and decannulation (454 ± 463 vs. 227 ± 232 days, p < 0.05).

At univariate analysis, presence of comorbidities was associated with decannulation rate (p < 0.05) and with number of additional procedures (p < 0.001).

Need for stent and nutrition tubes were more frequent in the HR group and stents had to be held longer (p < 0.05).

Conclusions:

Higher ELS-Score was associated with lower decannulation rate, longer time to decannulation, need for stents and onset of dysphagia requiring nutrition tubes.

Publication History

Publication Date:
23 April 2019 (online)