Supraglottoplasty outcomes in relation to age and comorbid conditions.
OBJECTIVE
To determine if age and comorbid conditions effect outcomes in children undergoing supraglottoplasty for severe laryngomalacia.


METHODS
Retrospective study.


METHODS
Urban tertiary-care children's hospital.


METHODS
Children undergoing supraglottoplasty for severe laryngomalacia between February 2004 and July 2008. 56 patients were identified.


METHODS
Persistence of upper airway obstruction, revision surgery (supraglottoplasty), and additional surgery (tracheostomy).


RESULTS
33/56 (58.9%) patients had no comorbid conditions and 23/56 (41.1%) patients had comorbid conditions. In noncomorbid patients, 36.4% of those less than 2 months of age at the time of surgery required revision supraglottoplasty, compared to 5.3% of patients between 2 and 10 months (p<0.05). Compared to the 2-10-month age group, there was a significantly higher percentage of patients with comorbid conditions in the >10-month group (32.1% vs. 79%, p<0.01). Patients with comorbid conditions were diagnosed at a significantly later age than those without (6 mo vs. 2 mo, respectively), and had significantly higher rates of revision supraglottoplasty (47.8% vs. 18.2%) and tracheostomy (39.1% vs. 0.0%). 70% of children with neurological conditions required revision surgery, with 60% requiring tracheostomy. The revision surgery and tracheostomy rates were significantly higher compared to the noncomorbid group (p<0.01 and p<0.0001). Children with cardiac conditions had a higher rate of tracheostomy than noncomorbid children (30% vs. 0%, p<0.01). 16.7% of children with genetic conditions required supraglottoplasty, and none required tracheostomy.


CONCLUSIONS
In noncomorbid patients, those undergoing supraglottoplasty less than 2 months of age had a significantly higher rate of revision supraglottoplasty. Patients with neurologic and cardiac comorbidities require tracheostomy at a significantly higher rate than noncomorbid patients.
Hoff
Stephen R
SR
Department of Otolaryngology-Head and Neck Surgery, University of Illinois Medical Center at Chicago, Chicago, IL, USA.
Schroeder
James W
JW
Rastatter
Jeff C
JC
Holinger
Lauren D
LD
D000367:Age Factors; D000402:Airway Obstruction / Q000453:epidemiology / Q000601:surgery; D001927:Brain Diseases / Q000453:epidemiology; D002675:Child, Preschool; D015897:Comorbidity; D019465:Craniofacial Abnormalities / Q000453:epidemiology; D005260:Female; D005931:Glottis / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000453:epidemiology; D006801:Humans; D007223:Infant; D055092:Laryngomalacia / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014139:Tracheostomy / Q000706:statistics & numerical data