Avni Bavishi1, Emily Boss2, Rahul K Shah3, Jennifer Lavin1,4. 1. Northwestern University, Feinberg School of Medicine, Chicago, IL 60611. 2. Johns Hopkins University, Baltimore, MD 21205. 3. Children's National Medical Center, Washington, DC 20010. 4. Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611.
Abstract
IMPORTANCE: Endoscopic management of pediatric subglottic stenosis (SGS) is common, however no multi-institutional studies have assessed its perioperative outcomes. The American College of Surgeon's National Surgical Quality Improvement Program - Pediatric (ACS-NSQIP-P) represents a source of such data. DESIGN: Current procedural terminology (CPT) codes were queried for endoscopic or open airway reconstruction in the ACS-NSQIP-P Public Use File (PUF). Demographics and 30-day events were abstracted to compare open to endoscopic techniques and to assess for risk factors for varied outcomes after endoscopic dilation. SETTING: National database. PARTICIPANTS: Patients with data reported in the 2015 ACS-NSQIP-P PUF. MEASUREMENTS: Length of stay (LOS), 30-day rates of reintubation, readmission and reoperation. RESULTS: 171 endoscopic and 116 open procedures were identified. Mean age at endoscopic and open procedures was 4.1 (SEM = 0.37) and 5.4 years (SEM = 0.40) respectively. Mean LOS was shorter after endoscopic procedures (5.5 days, SEM = 1.13 vs. 11.3 days SEM = 1.01, p = 0.0003). Open procedures had higher rates of reintubation (OR = 7.41, p = .026) and reoperation (OR = 3.09, p = .009). In patients undergoing endoscopic dilation, children <1 year were more likely to require readmission (OR=4.21, p=0.03) and reoperation (OR=4.39, p=0.03) when compared to older children. CONCLUSION: Open airway reconstruction is associated with longer LOS and increased reintubations and reoperations, suggesting a possible opportunity to improve value in healthcare in the appropriately selected patient. Reoperations and readmissions following endoscopic dilation are more prevalent in children less than one year.
IMPORTANCE: Endoscopic management of pediatric subglottic stenosis (SGS) is common, however no multi-institutional studies have assessed its perioperative outcomes. The American College of Surgeon's National Surgical Quality Improvement Program - Pediatric (ACS-NSQIP-P) represents a source of such data. DESIGN: Current procedural terminology (CPT) codes were queried for endoscopic or open airway reconstruction in the ACS-NSQIP-P Public Use File (PUF). Demographics and 30-day events were abstracted to compare open to endoscopic techniques and to assess for risk factors for varied outcomes after endoscopic dilation. SETTING: National database. PARTICIPANTS: Patients with data reported in the 2015 ACS-NSQIP-P PUF. MEASUREMENTS: Length of stay (LOS), 30-day rates of reintubation, readmission and reoperation. RESULTS: 171 endoscopic and 116 open procedures were identified. Mean age at endoscopic and open procedures was 4.1 (SEM = 0.37) and 5.4 years (SEM = 0.40) respectively. Mean LOS was shorter after endoscopic procedures (5.5 days, SEM = 1.13 vs. 11.3 days SEM = 1.01, p = 0.0003). Open procedures had higher rates of reintubation (OR = 7.41, p = .026) and reoperation (OR = 3.09, p = .009). In patients undergoing endoscopic dilation, children <1 year were more likely to require readmission (OR=4.21, p=0.03) and reoperation (OR=4.39, p=0.03) when compared to older children. CONCLUSION: Open airway reconstruction is associated with longer LOS and increased reintubations and reoperations, suggesting a possible opportunity to improve value in healthcare in the appropriately selected patient. Reoperations and readmissions following endoscopic dilation are more prevalent in children less than one year.
Authors: Mira Shiloach; Stanley K Frencher; Janet E Steeger; Katherine S Rowell; Kristine Bartzokis; Majed G Tomeh; Karen E Richards; Clifford Y Ko; Bruce L Hall Journal: J Am Coll Surg Date: 2009-11-22 Impact factor: 6.113