Outcomes of Cricotracheal Resection in Airway Reconstruction for Expanded Indications

Abstract

Objectives:

1) Describe expanded indications of cricotracheal resection (CTR) in airway reconstruction, including revision reconstruction and young age. 2) Define outcomes associated with expanded indications of CTR.

Methods:

Retrospective review of patients undergoing CTR at a tertiary care hospital from January 1, 2005, to December 31, 2011. Primary outcomes included decannulation rates and surgical success, defined as absence of symptoms at last follow-up. Logistic regression was used to examine age as a predictor of surgical success. Eighty patients were identified, with 68 patients having complete records available for review. Forty-nine patients were under 21 years of age.

Results:

In pediatric patients, surgical indications included stenosis (n = 43, 87.76%), A-frame deformity (n = 5, 10.2%), and laryngeal atresia (n = 1, 2%). Patients with subglottic stenosis (SGS) included 4 (9.3%) grade II, 34 (79.07%) grade III, and 5 (11.63%) grade IV. Thirty-eight patients (77.55%) were tracheostomy-dependent. Thirty-one patients (63.27%) had a history of prior airway surgery. Decannulation was achieved in 40 patients (81.63%); 36 patients (73.47%) were asymptomatic at last follow-up. Eight patients required additional open operation. Logistic regression analysis of pediatric patients showed over-all surgical success was associated with increased age (P = .02). Success rates between primary surgery and revisions were similar (67% vs. 77%, Fisher’s exact test, P = .51).

Conclusions:

In our pediatric cohort, we found success of CTR is associated with older age at time of reconstruction. There was no association between success and primary surgery, suggesting CTR remains a viable option in revision cases.