Author(s)
Emma Martin, MD
Yann-Fuu Kou, MD
Cynthia Wang, MD
Stephen Chorney, MD, MPH
Romaine Johnson, MD, MPH
Affiliation(s)
UT Southwestern Medical Center, Dallas, TX, USA
Abstract:
Introduction
Open airway reconstruction is a standard treatment for pediatric airway stenosis. Single-stage procedures rely on endotracheal tubes to stent the airway during healing, but the optimal duration of intubation is unclear. This study aimed to evaluate the impact of intubation duration on hospital length of stay (LOS) and complications.
Methods
We conducted a retrospective case series of airway reconstructions performed at a tertiary pediatric hospital from 2021–2025. Included were patients who underwent single-stage laryngotracheoplasty with anterior costal cartilage graft (LTP ACCG) or single-stage tracheal resection (TR). One patient was excluded for prolonged LOS due to social factors. Patients were grouped by intubation duration: =7 days or <7 days. Complications assessed included need for non-invasive positive pressure ventilation (NIPPV), reintubation, or revision surgery.
Results
A total of 33 patients were included: 16 underwent LTP ACCG and 17 underwent TR. In the LTP ACCG group, 3 patients were intubated =7 days (mean 8.3 days, LOS 24.7 days [SD 15.8]). One required NIPPV and reintubation. Fourteen patients were intubated <7 days (mean 2.7 days, LOS 10.5 days [SD 5.62]). Three required NIPPV, none were reintubated, but one with history of bilateral vocal cord paralysis (BLVCP) underwent suture lateralization. In the TR group, 6 patients were intubated =7 days (mean 7.7 days, LOS 20.5 days, [SD 7.97]). Two required NIPPV and reintubation. One had anastomotic dehiscence requiring tracheostomy replacement; another with BLVCP required a posterior graft. Eleven patients were intubated <7 days (mean 2.7 days, LOS 9.6 days [SD 2.58]). One required NIPPV and reintubation, and another had a small dehiscence requiring tracheostomy replacement.
Discussion
Open airway surgery involves patient-specific and surgeon-dependent decision-making regarding intubation duration. Our findings suggest that shorter intubation (<7 days) is associated with reduced LOS in both LTP ACCG and TR without increasing complication rates. While some patients with complex comorbidities may require prolonged intubation, a shorter duration may be safe and beneficial for many children.