Retrospective analysis of factors contributing to poor prognosis among 271 pediatric patients with tracheal stenosis treated with slide tracheoplasty.

Abstract

To determine factors contributing to adverse postsurgical outcomes in children with congenital tracheal stenosis (CTS) treated with slide tracheoplasty (STP). 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. 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. Careful assessment and management of perioperative conditions are essential to minimize risk of adverse postsurgical outcomes in patients with CTS undergoing STP.