A comprehensive 10-year review of decannulation and perioperative complications in pediatric open airway reconstruction.

PURPOSE: To characterize perioperative morbidity, microbiologic findings and decannulation outcomes in pediatric open airway reconstruction. METHODS: All children undergoing open airway reconstruction between 2014 and 2024 were included. Demographic characteristics, stenosis grade, surgical technique, staging strategy, stent use, graft configuration, postoperative complications, microbiological findings, and decannulation outcomes were analyzed. RESULTS: Forty-four children (mean age, 4.1 ± 2.9 years) underwent open airway reconstruction, most with high-grade stenosis (60% grade III, 34% grade IV). Procedures included laryngotracheoplasty (n = 35), cricotracheal resection (n = 7), and tracheal resection (n = 2). Single-stage reconstruction was performed in 24 patients (54.5%) and double-stage in 20 (45.5%). Airway stents were used in 31 of 44 patients (70.5%), with a significant decline over time (85.7% vs. 43.8%; P < .01). Overall, 70.5% achieved decannulation, including 68.2% within 6 months. Single-stage reconstruction was associated with a shorter median time to decannulation compared with double-stage reconstruction (median, 0.26 vs. 3.27 months; P = .004). All postoperative infections occurred in stented patients (29% vs. 0%; P = .03(, representing a more clinically complex subgroup. Multivariable analysis demonstrated an independent association between stenosis severity and delayed decannulation. CONCLUSION: Outcomes after pediatric open airway reconstruction were associated with surgical staging, stent use, and perioperative factors. These findings support individualized treatment strategies and outcome assessment beyond decannulation alone.