title: Laryngotracheal reconstruction: a ten-year review of risk factors for decannulation failure.
abstract: OBJECTIVE
  To determine risk factors for decannulation failure after laryngotracheal reconstruction performed at a single institution over a 10-year period.
  
  
  METHODS
  This is a retrospective cohort study.
  
  
  METHODS
  The study population included 95 adult patients who underwent laryngotracheal reconstruction at a single tertiary care medical center between 2003 and 2012. Data were retrospectively reviewed.
  
  
  RESULTS
  Our cohort consisted of 95 subjects (60% female) with a median (range) age of 48 (21-82) years. Fourteen patients failed to decannulate by one postoperative year and were more likely to have diabetes, gastroesophageal reflux disease, grade 4 stenosis, T-tube requirement, secondary tracheotomy, double-stage reconstruction, and more endoscopic dilations within the first postoperative year. T-tube requirement was highly predictive of decannulation failure, with an odds ratio of 50.6 in univariate analysis and 93.7 in multivariate analysis. Grade 4 stenosis and a requirement of at least one postoperative endoscopic dilation were also found significant under both univariate and multivariate models. Gastroesophageal reflux disease was marginally significant under the univariate and multivariate models (P = .059 and .088, respectively).
  
  
  CONCLUSIONS
  The presence of preoperative and postoperative factors may indicate a higher risk of decannulation failure after laryngotracheal reconstruction. Patients with diabetes, gastroesophageal reflux disease, and grade 4 stenosis are at higher risk for decannulation failure. Requirement of T-tube placement and requirement of endoscopic dilation are predictive of decannulation failure.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Kareem O
authors.initials: KO
authors.lastname: Tawfik
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Houlton
authors.forename: William
authors.initials: W
authors.lastname: Compton
authors.forename: Jun
authors.initials: J
authors.lastname: Ying
authors.forename: Siddarth M
authors.initials: SM
authors.lastname: Khosla
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007829:Laryngostenosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D014135:Tracheal Stenosis / Q000209:etiology / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects* / Q000295:instrumentation; D055815:Young Adult
keywords: Laryngology; gastroesophageal reflux; laryngotracheal reconstruction; obesity; smoking; subglottic stenosis; tobacco; tracheal reconstruction; tracheal stenosis; tracheostomy dependence