title: Modified Best-Practice Algorithm to Reduce the Number of Postoperative Videofluoroscopic Swallow Studies in Patients With Type 1 Laryngeal Cleft Repair.
abstract: There is no consensus as to the timing of videofluoroscopic swallow studies (VFSSs) in determining resolving aspiration after laryngeal cleft repair. There is a growing literature on the effect of radiation exposure in children.
  
  
  
  To modify a previously published best-practice algorithm based on a literature review and our clinical experience to maintain the quality of care provided after successful type 1 laryngeal cleft repair, while reducing the total number of postoperative VFSSs by 10% or greater.
  
  
  
  The previously published algorithm was modified by a multidisciplinary group at a tertiary care academic medical center (Massachusetts Eye and Ear) and was prospectively applied to 31 children who underwent type 1 laryngeal cleft repair from January 1, 2013, to February 28, 2015.
  
  
  
  The number of VFSSs obtained in the first 7 months after surgery was compared with the peer-reviewed literature and with a retrospective cohort of 27 patients who underwent type 1 laryngeal cleft repair from January 1, 2008, to December 31, 2012.
  
  
  
  The study cohort comprised 31 patients. Their ages ranged from 10 to 48 months, with a mean (SD) age of 23.94 (9.93) months, and 19% (6 of 31) were female. The mean (SD) number of postoperative VFSSs per patient before and after implementation of the algorithm was 1.22 (0.42) and 1.03 (0.55), respectively. The use of the algorithm reduced the number of VFSSs by 0.19 (95% CI, -0.07 to 0.45). This reduction in radiation exposure is equivalent to 1.47 chest radiographs per child per course of care. Surgical success was 87% (27 of 31) compared with our group's previously published success rate of 78% (21 of 27) (absolute difference, 0.09; 95% CI, -0.17 to 0.34).
  
  
  
  This modified algorithm to help guide decisions on when and how often to obtain VFSSs after type 1 laryngeal cleft repair can limit patients' radiation exposure, while maintaining high surgical success rates.
authors.affiliation: Pediatric Otolaryngology Service, Massachusetts Eye and Ear, Boston.
authors.forename: Carissa
authors.initials: C
authors.lastname: Wentland
authors.affiliation: Department of Speech, Language and Swallowing Disorders, Massachusetts General Hospital, Boston.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Hersh
authors.affiliation: Department of Speech, Language and Swallowing Disorders, Massachusetts General Hospital, Boston.
authors.forename: Sarah
authors.initials: S
authors.lastname: Sally
authors.affiliation: Pediatric Pulmonology Service, Massachusetts General Hospital, Boston.
authors.forename: M Shannon
authors.initials: MS
authors.lastname: Fracchia
authors.affiliation: Pediatric Gastroenterology Service, Massachusetts General Hospital, Boston.
authors.forename: Steven
authors.initials: S
authors.lastname: Hardy
authors.affiliation: Department of Imaging, Massachusetts General Hospital, Boston.
authors.forename: Bob
authors.initials: B
authors.lastname: Liu
authors.affiliation: Department of Otolaryngology (ENT), Harvard Medical School, Massachusetts Eye and Ear, Boston.
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Garcia
authors.affiliation: Pediatric Otolaryngology Service, Massachusetts Eye and Ear, Boston.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hartnick
mesh_terms: D000465:Algorithms; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D003679:Deglutition; D005260:Female; D005471:Fluoroscopy / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007830:Larynx / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control; D011184:Postoperative Period; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000517:prevention & control*; D053120:Respiratory Aspiration / Q000150:complications / Q000000981:diagnostic imaging*; D014741:Video Recording