Long-segment tracheal stenosis: slide tracheoplasty and a multidisciplinary approach improve outcomes and reduce costs.
OBJECTIVE
Long-segment tracheal stenosis is rare, life-threatening, difficult, and expensive to treat. Management remains controversial. A multidisciplinary tracheal team was formed in 2000 to deal with a large number of children with airway problems referred for management. We review the effect of that service, comparing the era before and after the establishment of the multidisciplinary tracheal team.


METHODS
From January 1998 through January 2004, 34 patients with long-segment tracheal stenosis (21 patients with cardiovascular anomalies) underwent surgical intervention. Cardiopulmonary bypass was used in all operations. Before the multidisciplinary tracheal team, pericardial patch tracheoplasty with or without an autograft technique was the preferred method of repair. After the multidisciplinary tracheal team, an integrated care plan preferring slide tracheoplasty was initiated, correcting cardiac lesions simultaneously.


RESULTS
Before the establishment of the multidisciplinary tracheal team, pericardial patch tracheoplasty was performed in 15 of 19 patients. Twelve patients had a suspended pericardial patch tracheoplasty, 2 (17%) of whom died late after the operation. Of 3 patients who had had a simple unsuspended patch, 2 (67%) died early after the operation. Four patients were operated on with the tracheal autograft technique, 2 (50%) dying early in the postoperative period. After multidisciplinary tracheal team formation, in the era between 2001 and 2004, 15 patients were operated on with slide tracheoplasty, and there were 2 (13%) early postoperative deaths. A significant reduction in cost and duration of stay has been shown both in the intensive care unit and the hospital.


CONCLUSIONS
Our data suggest that a formalized multidisciplinary team approach and a policy of primary slide tracheoplasty are beneficial in the management of children with long-segment tracheal stenosis.
Kocyildirim
Ergin
E
Tracheal Team, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK.
Kanani
Mazyar
M
Roebuck
Derek
D
Wallis
Colin
C
McLaren
Clare
C
Noctor
Clair
C
Pigott
Nick
N
Mok
Quen
Q
Hartley
Ben
B
Dunne
Catherine
C
Uppal
Savjeet
S
Elliott
Martin J
MJ
D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications; D017721:Hospital Costs; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D010348:Patient Care Team; D011785:Quality Assurance, Health Care / Q000379:methods*; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery*; D014135:Tracheal Stenosis / Q000150:complications / Q000191:economics / Q000601:surgery*; D016896:Treatment Outcome; D006113:United Kingdom