Abstract：
OBJECTIVE: To determine whether socioeconomic disadvantage impacts outcomes after pediatric laryngotracheoplasty.
METHODS: 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.
METHODS:
METHODS: 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.
METHODS:
摘要：
目的：确定儿童喉气管成形术后的社会经济劣势是否会影响预后。
方法：带图表审查的案例系列。
方法：纳入2010年至2019年在三级儿童医院进行的所有喉气管成形术。主要邮政编码确定区域剥夺指数(ADI)，经过验证的社会经济脆弱性度量，儿童根据社区劣势的减少或增加进行分组。主要结果包括并发症和拔管率。
结果：包括84个程序，其中69％（58/84）的双阶段重建和31％（26/84）的单阶段重建。手术年龄中位数为3.2（IQR2.2-4.9）岁，56%（47/84）为男性，中位胎龄为25(IQR24-28)周。来自更弱势社区的儿童占手术的67％（56/84），并且更有可能患有更高级别的狭窄（89％vs.64%,P=.02）。术后气道并发症（20%vs.18%,P=.99)，非气道并发症（14%vs.18%,P=.75)，和总停留时间(7vs.6天,P=.26)不受ADI分组的影响。虽然社区劣势较高的儿童在双阶段手术后同样可能被拔管(76%vs.76%,P=.99)，它通常需要超过六个月的时间才能实现(90%与61%,P=.04）。
结论：在需要扩张气道手术的儿童中，社区劣势与更严重的气道狭窄和更长时间的成功拔管相关。令人鼓舞的是，ADI分组不影响并发症和拔管率。需要继续工作来了解社会经济学指标如何影响儿科开放气道手术。
方法：带图表审查的案例系列。
方法：纳入2010年至2019年在三级儿童医院进行的所有喉气管成形术。主要邮政编码确定区域剥夺指数(ADI)，经过验证的社会经济脆弱性度量，儿童根据社区劣势的减少或增加进行分组。主要结果包括并发症和拔管率。
结果：包括84个程序，其中69％（58/84）的双阶段重建和31％（26/84）的单阶段重建。手术年龄中位数为3.2（IQR2.2-4.9）岁，56%（47/84）为男性，中位胎龄为25(IQR24-28)周。来自更弱势社区的儿童占手术的67％（56/84），并且更有可能患有更高级别的狭窄（89％vs.64%,P=.02）。术后气道并发症（20%vs.18%,P=.99)，非气道并发症（14%vs.18%,P=.75)，和总停留时间(7vs.6天,P=.26)不受ADI分组的影响。虽然社区劣势较高的儿童在双阶段手术后同样可能被拔管(76%vs.76%,P=.99)，它通常需要超过六个月的时间才能实现(90%与61%,P=.04）。
结论：在需要扩张气道手术的儿童中，社区劣势与更严重的气道狭窄和更长时间的成功拔管相关。令人鼓舞的是，ADI分组不影响并发症和拔管率。需要继续工作来了解社会经济学指标如何影响儿科开放气道手术。
