TY - JOUR
T1 - Assessment of socioeconomic disadvantage in laryngotracheoplasty outcomes among pediatric patients
AU - Kou, Yann Fuu
AU - Teplitzky, Taylor
AU - Johnson, Romaine F.
AU - Chorney, Stephen R.
N1 - Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2022/11
Y1 - 2022/11
N2 - Objectives: To determine whether socioeconomic disadvantage impacts outcomes after pediatric laryngotracheoplasty. Study design: Case series with chart review. Methods: All laryngotracheoplasty procedures at a tertiary children's hospital between 2010 and 2019 were included. Primary zip code determined Area Deprivation Index (ADI), a validated socioeconomic vulnerability measure, and children were grouped based on less or more community disadvantage. Primary outcomes included complication and decannulation rates. Results: Eighty-four procedures were included with 69% (58/84) double-stage and 31% (26/84) single-stage reconstructions. Median age at surgery was 3.2 (IQR 2.2–4.9) years, 56% (47/84) were male, and median gestational age was 25 (IQR 24–28) weeks. Children from more disadvantaged communities represented 67% (56/84) of surgeries and were more likely to have higher grade stenosis (89% vs. 64%, P = .02). Postoperative airway complications (20% vs. 18%, P = .99), non-airway complications (14% vs. 18%, P = .75), and total length of stay (7 vs. 6 days, P = .26) were not impacted by ADI grouping. While children from higher community disadvantage were just as likely to be decannulated after double stage surgeries (76% vs. 76%, P = .99), it more often took longer than six months to achieve (90% vs. 61%, P = .04). Conclusions: Community disadvantage is associated with higher grade airway stenosis and longer times to successful decannulation in children requiring expansion airway surgery. Encouragingly, ADI grouping did not impact complication and decannulation rates. Continued work is needed to understand how socioeconomic metrics influence pediatric open airway surgery. Level of evidence: 4.
AB - Objectives: To determine whether socioeconomic disadvantage impacts outcomes after pediatric laryngotracheoplasty. Study design: Case series with chart review. Methods: All laryngotracheoplasty procedures at a tertiary children's hospital between 2010 and 2019 were included. Primary zip code determined Area Deprivation Index (ADI), a validated socioeconomic vulnerability measure, and children were grouped based on less or more community disadvantage. Primary outcomes included complication and decannulation rates. Results: Eighty-four procedures were included with 69% (58/84) double-stage and 31% (26/84) single-stage reconstructions. Median age at surgery was 3.2 (IQR 2.2–4.9) years, 56% (47/84) were male, and median gestational age was 25 (IQR 24–28) weeks. Children from more disadvantaged communities represented 67% (56/84) of surgeries and were more likely to have higher grade stenosis (89% vs. 64%, P = .02). Postoperative airway complications (20% vs. 18%, P = .99), non-airway complications (14% vs. 18%, P = .75), and total length of stay (7 vs. 6 days, P = .26) were not impacted by ADI grouping. While children from higher community disadvantage were just as likely to be decannulated after double stage surgeries (76% vs. 76%, P = .99), it more often took longer than six months to achieve (90% vs. 61%, P = .04). Conclusions: Community disadvantage is associated with higher grade airway stenosis and longer times to successful decannulation in children requiring expansion airway surgery. Encouragingly, ADI grouping did not impact complication and decannulation rates. Continued work is needed to understand how socioeconomic metrics influence pediatric open airway surgery. Level of evidence: 4.
KW - Decannulation
KW - Laryngotracheal reconstruction
KW - Pediatric airway surgery
KW - Socioeconomic disadvantage
UR - http://www.scopus.com/inward/record.url?scp=85138823693&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85138823693&partnerID=8YFLogxK
U2 - 10.1016/j.ijporl.2022.111326
DO - 10.1016/j.ijporl.2022.111326
M3 - Article
C2 - 36174480
AN - SCOPUS:85138823693
SN - 0165-5876
VL - 162
JO - International Journal of Pediatric Otorhinolaryngology
JF - International Journal of Pediatric Otorhinolaryngology
M1 - 111326
ER -