The Journal of thoracic and cardiovascular surgery · 2024
Retrospective analysis of factors contributing to poor prognosis among 271 pediatric patients with tracheal stenosis treated with slide tracheoplasty.
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Chen Yu, Wen Wanyu, Du Xinwei, Wang Hao, Zhu Limin, Wang Shunmin, Hong Li, Lu Zhaohui, Xiang Ying
Аннотация
OBJECTIVE: To determine factors contributing to adverse postsurgical outcomes in children with congenital tracheal stenosis (CTS) treated with slide tracheoplasty (STP).
METHODS: We employed regression models to evaluate the impact of preoperative or intraoperative features on postoperative airway complications, mechanical ventilation time, hospitalization, and survival among STP-treated patients with CTS.
RESULTS: Outcomes from 271 patients with CTS undergoing STP were analyzed. Multivariate analysis showed that unilateral lung hypoplasia (odds ratio [OR], 4.859; 95% confidence interval [CI], 1.355-17.427) and bilateral bronchomalacia (OR, 3.774; 95% CI, 1.364-10.440) contributed to postoperative airway complications. Full-length stenosis (β = 0.192; 95% CI, 0.077-0.308), bilateral bronchomalacia (β = 0.153; 95% CI, 0.039-0.266), and secondary surgery (β = 0.269; 95% CI, 0.154-0.384) accounted for increased mechanical ventilation time. Using 99 hours as a benchmark, weight (OR, 0.818; 95% CI, 0.677-0.988) and bilateral bronchomalacia (OR, 2.960; 95% CI, 1.314-6.666) were factors for prolonged mechanical ventilation time. In addition, full-length stenosis (β = 0.221; 95% CI, 0.108-0.334), unilateral lung hypoplasia (β = 0.170; 95% CI, 0.060-0.280), unilateral bronchomalacia (β = 0.151; 95% CI, 0.038-0.265), and secondary surgery (β = 0.247; 95% CI, 0.138-0.356) were positively associated with the duration of hospitalization, whereas weight (β = -0.307; 95% CI, -0.561 to -0.054) was negatively correlated. Taking 21 days as a benchmark, weight (OR, 0.712; 95% CI, 0.569-0.891), full-length stenosis (OR, 2.997; 95% CI, 1.530-5.871), unilateral lung hypoplasia (OR, 10.079; 95% CI, 2.267-44.811), and reoperation (OR, 24.176; 95% CI, 2.685-217.667) associated with prolonged hospital stay. Weight (hazard ratio [HR], 0.167; 95% CI, 0.030-0.949) and tracheal diameter (HR, 0.172; 95% CI, 0.043-0.684) were positively correlated with survival.
CONCLUSIONS: Careful assessment and management of perioperative conditions are essential to minimize risk of adverse postsurgical outcomes in patients with CTS undergoing STP.
METHODS: We employed regression models to evaluate the impact of preoperative or intraoperative features on postoperative airway complications, mechanical ventilation time, hospitalization, and survival among STP-treated patients with CTS.
RESULTS: Outcomes from 271 patients with CTS undergoing STP were analyzed. Multivariate analysis showed that unilateral lung hypoplasia (odds ratio [OR], 4.859; 95% confidence interval [CI], 1.355-17.427) and bilateral bronchomalacia (OR, 3.774; 95% CI, 1.364-10.440) contributed to postoperative airway complications. Full-length stenosis (β = 0.192; 95% CI, 0.077-0.308), bilateral bronchomalacia (β = 0.153; 95% CI, 0.039-0.266), and secondary surgery (β = 0.269; 95% CI, 0.154-0.384) accounted for increased mechanical ventilation time. Using 99 hours as a benchmark, weight (OR, 0.818; 95% CI, 0.677-0.988) and bilateral bronchomalacia (OR, 2.960; 95% CI, 1.314-6.666) were factors for prolonged mechanical ventilation time. In addition, full-length stenosis (β = 0.221; 95% CI, 0.108-0.334), unilateral lung hypoplasia (β = 0.170; 95% CI, 0.060-0.280), unilateral bronchomalacia (β = 0.151; 95% CI, 0.038-0.265), and secondary surgery (β = 0.247; 95% CI, 0.138-0.356) were positively associated with the duration of hospitalization, whereas weight (β = -0.307; 95% CI, -0.561 to -0.054) was negatively correlated. Taking 21 days as a benchmark, weight (OR, 0.712; 95% CI, 0.569-0.891), full-length stenosis (OR, 2.997; 95% CI, 1.530-5.871), unilateral lung hypoplasia (OR, 10.079; 95% CI, 2.267-44.811), and reoperation (OR, 24.176; 95% CI, 2.685-217.667) associated with prolonged hospital stay. Weight (hazard ratio [HR], 0.167; 95% CI, 0.030-0.949) and tracheal diameter (HR, 0.172; 95% CI, 0.043-0.684) were positively correlated with survival.
CONCLUSIONS: Careful assessment and management of perioperative conditions are essential to minimize risk of adverse postsurgical outcomes in patients with CTS undergoing STP.