Laryngotracheal Reconstruction in Adults Aged 60 Years and Older

Document Type

Article

Abstract

OBJECTIVE: The primary aim of this study is to evaluate the safety, efficacy, and execution of major open laryngotracheal operations for patients in the advanced decades. STUDY DESIGN: Case series with chart review. SETTING: Multidisciplinary clinic at a tertiary care academic hospital. SUBJECTS AND METHODS: Patient characteristics, operative course, and postoperative outcomes were retrospectively recorded for all airway reconstruction operations performed between 1999 and 2016 on patients aged =60 years Long-term success was defined as prosthesis-free survival at last follow-up. Descriptive statistics were performed. RESULTS: Twenty-nine patients met inclusion criteria, and the median age was 71 years (interquartile range, 63-74). Tracheal resection was the most common procedure (13 patients), followed by laryngotracheal reconstruction (7 patients). Fifteen patients began their operation with a tracheostomy, 6 of whom underwent decannulation prior to leaving the operating room. Three additional patients underwent decannulation at follow-up appointments and were prosthesis-free at most recent follow-up. The mean time to decannulation among these patients was 3 months. Of the 14 patients beginning their procedure without a tracheostomy, only 2 required permanent airway prosthesis. The overall long-term rate of prosthesis-free survival was 72.4% (21 of 29 patients). Factors suggestive of long-term success include lower McCaffrey grade and lack of pulmonary disease, hypertension, or diabetes, as well as decreased red blood cell distribution width on preoperative complete blood count. CONCLUSION: Through careful patient selection, preoperative workup, and meticulous postoperative care, airway reconstruction procedures in patients aged =60 years are reasonably successful. Of 29 patients, 21 (72.4%) were successfully breathing long-term without airway prosthesis.

Medical Subject Headings

Age Factors; Aged; Aged, 80 and over; Female; Humans; Laryngostenosis (surgery); Male; Middle Aged; Plastic Surgery Procedures; Retrospective Studies; Tracheal Stenosis (surgery); Tracheostomy; Treatment Outcome

Publication Date

6-1-2019

Publication Title

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery

E-ISSN

1097-6817

Volume

160

Issue

6

First Page

1065

Last Page

1070

PubMed ID

30717620

Digital Object Identifier (DOI)

10.1177/0194599818825471

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