1
|
Trabalza Marinucci B, Fiorelli S, Siciliani A, Menna C, Tiracorrendo M, Massullo D, Venuta F, Rendina EA, Ciccone AM, D’Andrilli A, Ibrahim M, Maurizi G. New Insight into Laryngo-Tracheal Surgery: High-Flow Oxygen Therapy to Prevent Early Complications after Surgery. J Pers Med 2024; 14:456. [PMID: 38793037 PMCID: PMC11122413 DOI: 10.3390/jpm14050456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/09/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Early post-operative airway management after laryngo-tracheal surgery is crucial. Acute respiratory failure due to glottis' edema may occur, requiring reintubation. This can prolong ventilatory assistance, jeopardizing anastomosis. To date, only judicious steroid administration and fluid management are available to avoid more invasive procedures. High-flow oxygen therapy (HFOT) is a noninvasive O2 support method providing humidification, warmed air, and Positive End-Expiratory Pressure (AIRVO2). No data about HFOT use to prevent early complications after laryngo-tracheal surgery are reported in the literature. METHODS Between September 2020 and September 2022, 107 consecutive patients who underwent laryngo-tracheal surgery received HFOT (Group A). Data and long-term results were compared with those of 80 patients operated between September 2018 and August 2020 (Group B), when HFOT was not available. All patients were operated in a single center. No pre- or post-operative settings changed, except for HFOT introduction. We analyzed and compared the risk for "delayed" reintubation (unexpected reintubation within the first 24-48 h after extubating/laryngeal mask removal) in the two groups. RESULTS No patients reported HFOT-related adverse events. The control group (B) presented "delayed" reintubation in 37% (p = 0.027), intensive care unit admission in 67% (p = 0.005) and longer hospital stay (p = 0.001) compared to the HFOT group (A). The minor complications' rate was 3% in both group and overall mortality was 0%. Re-stenosis was described in 4.6% of the HFOT group, without a statistically significant difference (p = 0.7006). CONCLUSIONS Our study is the first to investigate HFOT use in patients undergoing laryngo-tracheal surgery, potentially representing a consistent innovation in the peri-operative management of these patients. With the limitation of a retrospective series, we would suggest HFOT use for preventing post-operative reintubation rate, possibly reducing ICU admissions and hospital stays.
Collapse
Affiliation(s)
- Beatrice Trabalza Marinucci
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Silvia Fiorelli
- Anesthesiology and Intensive Care, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy; (S.F.); (D.M.)
| | - Alessandra Siciliani
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Cecilia Menna
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Matteo Tiracorrendo
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Domenico Massullo
- Anesthesiology and Intensive Care, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy; (S.F.); (D.M.)
| | - Federico Venuta
- Thoracic Surgery Policlinico Umberto I, La Sapienza University, 00186 Rome, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Anna Maria Ciccone
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Antonio D’Andrilli
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Mohsen Ibrahim
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| | - Giulio Maurizi
- Thoracic Surgery, Sant’Andrea, Hospital, La Sapienza University, 00189 Rome, Italy; (A.S.); (C.M.); (M.T.); (E.A.R.); (A.M.C.); (A.D.); (M.I.); (G.M.)
| |
Collapse
|
2
|
Aigner C. Long segment stenosis-the narrow path to centralization in airway surgery. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae004. [PMID: 38216537 PMCID: PMC10858342 DOI: 10.1093/icvts/ivae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Affiliation(s)
- Clemens Aigner
- Department of Thoracic Surgery, Comprehensive Center for Chest Disease, Medical University of Vienna—Vienna University Hospital, Vienna, Austria
| |
Collapse
|
3
|
Bibas BJ, Minamoto H, Cardoso PFG, Cremonese MR, Pêgo-Fernandes PM, Terra RM. Brazilian airway surgery survey indicates low overall numbers and need for improved teaching skills. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivad177. [PMID: 37950507 PMCID: PMC10858343 DOI: 10.1093/icvts/ivad177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The Brazilian Society of Thoracic Surgeons conducted an online survey to determine the number of surgeons that perform adult and paediatric airway surgery and to understand the practice patterns along the country. METHODS Active members were electronically invited to complete the questionnaire through the REDCapR platform. Invitations were sent from January to April 2020. The survey encompassed 40 questions that explored 4 different topics in the assessment of tracheal diseases: (i) surgeon's demography; (ii) institutional profile, (iii) education and training in laryngo-tracheal surgery and (iv) preoperative and postoperative evaluation. RESULTS Eighty-nine percentage of the responders declared to perform tracheal surgery with a median of 5 tracheal resection procedures per year [interquartile range (IQR) 3-12]. Interaction with other specialties occurs in 37.3% of cases. Access to technology and devices is highly variable across the country. Resident training in airway surgery consists in traditional lectures in 97% of the cases. Training in animals (15.2%), cadavers (12.1%) and simulators (6.1%) are rare. Preoperatory evaluation encompasses flexible bronchoscopy (97.8%) and/or computed tomography (CT) scan of the airways (90.6%). Swallowing (20.1%) and voice (14.4%) disorders are rarely evaluated. Eighty-nine percentage of the surgeons consider bronchoscopy to be the preoperatory gold-standard exam, followed by CT scan (38.8%) and CT-3D reconstruction (37.4%). CONCLUSIONS Brazilian surgeons refer that airway resection and reconstruction are part of their current practice, but the total number of procedures per surgeon per year is low. Access to high-end technology and equipment is heterogenous. Training offered to residents in most academic institutions relies on traditional lectures.
Collapse
Affiliation(s)
- Benoit Jacques Bibas
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Hospital Municipal Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Helio Minamoto
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo Francisco G Cardoso
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mariana Rodrigues Cremonese
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Hospital Municipal Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ricardo Mingarini Terra
- Disciplina de Cirurgia Torácica, Instituto do Coração (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| |
Collapse
|
4
|
Defosse J, Schieren M, Hartmann B, Egyed E, Koryllos A, Stoelben E, Wappler F, Böhmer A. A New Approach in Airway Management for Tracheal Resection and Anastomosis: A Single-Center Prospective Study. J Cardiothorac Vasc Anesth 2022; 36:3817-3823. [PMID: 35798632 DOI: 10.1053/j.jvca.2022.05.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The evaluation of the use of laryngeal mask airways (LMA) as an alternative form of airway management for surgical tracheal reconstruction. DESIGN A prospective case series. SETTING At a single German university hospital. PARTICIPANTS Ten patients. INTERVENTIONS The use of LMA for airway management in surgical reconstruction of the trachea. MEASUREMENTS AND MAIN RESULTS Ten patients with tracheal stenosis of 50% to 90% were enrolled prospectively during the study period. The airway management consisted of the insertion of an LMA. During resection and reconstruction, high-frequency jet ventilation was used. Several arterial blood gas analyses (ABG) were performed before, during, and after the tracheal resection and reconstruction. All values were presented as median and interquartile ranges or as absolute and relative values, and no emergency change to cross-field intubation was necessary. The lowest PaO2 was 93 mmHg in 1 patient after 20 minutes of jet ventilation, whereas PaO2 increased after the induction phase and remained stable in 9 patients. There were no intraoperative complications related to anesthetic management apart from transient hypercarbia during and after jet ventilation. Preoperative and postoperative ABG were comparable. One patient required immediate postoperative ventilatory support. Two patients developed postoperative pneumonia, leading to their admission to the intensive care unit. One patient was operated with a palliative approach due to massive dyspnea and died in the next postoperative course. CONCLUSIONS The use of LMA is an alternative option in airway management for tracheal reconstruction, even in patients with significant tracheal stenosis. Potential advantages compared to tracheal intubation are unimpaired access to the operative field and the lack of stress on the fresh anastomosis.
Collapse
Affiliation(s)
- Jerome Defosse
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany.
| | - Mark Schieren
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Burkhard Hartmann
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Enikö Egyed
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Aris Koryllos
- Witten/Herdecke University, Medical Center Cologne-Merheim, Lung Clinic, Thoracic Surgery, Cologne, Germany
| | - Erich Stoelben
- Witten/Herdecke University, Medical Center Cologne-Merheim, Lung Clinic, Thoracic Surgery, Cologne, Germany
| | - Frank Wappler
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Andreas Böhmer
- Witten/Herdecke University, Medical Center Cologne-Merheim, Department of Anesthesiology and Intensive Care Medicine, Cologne, Germany
| |
Collapse
|
5
|
Beyoglu MA, Sahin MF, Turkkan S, Yazicioglu A, Yekeler E. Complex Post-intubation Tracheal Stenosis in Covid-19 Patients. Indian J Surg 2022; 84:805-813. [PMID: 35818393 PMCID: PMC9261125 DOI: 10.1007/s12262-022-03498-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 07/01/2022] [Indexed: 11/26/2022] Open
Abstract
Management of tracheal complications due to endotracheal intubation in patients with coronavirus disease-2019 (COVID-19) is an important concern. This study aimed to present the results of patients who had undergone tracheal resection and reconstruction due to COVID-19-related complex post-intubation tracheal stenosis (PITS). We evaluated 15 patients who underwent tracheal resection and reconstruction due to complex PITS between March 2020 and April 2021 in a single center. Seven patients (46.6%) who underwent endotracheal intubation due to the COVID-19 constituted the COVID-19 group, and the remaining 8 patients (53.4%) constituted the non-COVID-19 group. We analyzed the patients’ presenting symptoms, time to onset of symptoms, radiological and bronchoscopic features of stenosis, bronchoscopic intervention history, length of the resected tracheal segment, postoperative complications, length of hospital stay, and duration of follow-up. Six of the patients (40%) were female, and 9 (60%) were male. Mean age was 43.3 ± 20.5. We found no statistically significant difference between the COVID-19 and non-COVID-19 PITS groups in terms of presenting symptoms, time to onset of symptoms, stenosis location, stenosis severity, length of the stenotic segment, number of bronchoscopic dilatation sessions, dilatation time intervals, length of the resected tracheal segment, postoperative complications, and length of postoperative hospital stay. Endotracheal intubation duration was longer in the COVID-19 group than non-COVID-19 group (mean ± SD: 21.0 ± 4.04, 12.0 ± 1.15 days, respectively). Tracheal resection and reconstruction can be performed safely and successfully in COVID-19 patients with complex PITS. Comprehensive preoperative examination, appropriate selection of surgery technique, and close postoperative follow-up have favorable results.
Collapse
Affiliation(s)
- Muhammet Ali Beyoglu
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, MH2 Binasi, B1 Kati, E2 Bolumu, Universiteler Mahallesi 1604, Cadde No: 9, Çankaya, Ankara, Turkey
| | - Mehmet Furkan Sahin
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, MH2 Binasi, B1 Kati, E2 Bolumu, Universiteler Mahallesi 1604, Cadde No: 9, Çankaya, Ankara, Turkey
| | - Sinan Turkkan
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, MH2 Binasi, B1 Kati, E2 Bolumu, Universiteler Mahallesi 1604, Cadde No: 9, Çankaya, Ankara, Turkey
| | - Alkin Yazicioglu
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, MH2 Binasi, B1 Kati, E2 Bolumu, Universiteler Mahallesi 1604, Cadde No: 9, Çankaya, Ankara, Turkey
| | - Erdal Yekeler
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, MH2 Binasi, B1 Kati, E2 Bolumu, Universiteler Mahallesi 1604, Cadde No: 9, Çankaya, Ankara, Turkey
| |
Collapse
|
6
|
Slama A, Zaatar M, Demir M, Okumus O, Mattheis S, Kampe S, Darwiche K, Lang S, Aigner C. Tracheal Resection after Previous Treatment Provides Comparable Outcome to Primary Surgery. Thorac Cardiovasc Surg 2021; 70:505-512. [PMID: 34062598 DOI: 10.1055/s-0041-1728772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tracheal and laryngotracheal surgery provides both excellent functional results and long-term outcomes in the treatment of tracheal stenosis. Consequently, challenging re-resections are rarely necessary. The purpose of this study was to compare the outcome of (laryngo-)tracheal re-resection and surgery after bronchoscopic interventions with that of primary surgery. METHODS Patients undergoing resection for benign tracheal stenosis at our center between 1/2016 and 4/2020 were included. Perioperative characteristics and functional outcomes of patients were used for statistical analysis. RESULTS Sixty-six patients who underwent (laryngo-)tracheal resection were included (previous resection [A = 6], previous stent [B = 6], previous bronchoscopic intervention w/o stenting [C = 19], untreated [D = 35]). Baseline parameters were largely comparable between groups with exception from group B that had significantly worse lung function. Group A necessitated more complex reconstructions (end-to-end: n = 1: 17%| cricotracheal n = 2: 33%| cricotracheal with mucosectomy n = 2: 33%| laryngoplasty: n = 1: 17%) than patients in group D (end-to-end n = 21: 60%| cricotracheal n = 14: 40%). Postoperative outcomes were comparable throughout groups (intensive care unit: 1[1-18] days; hospital stay: 8[5-71] days). Anastomotic complications were higher after previous stenting (A: 0%; B: 33.3%; C: 10.5%; D: 2.9%; B/D p = 0.008| surgical revisions: A: 16.7%; B: 33.3%; C: 0%; D: 5.7%; B/D, p = 0.035). Overall, postoperative lung function was significantly better (forced expiratory volume in 1 second: 63% ± 24 vs. 75% ± 20; p = 0.001 | PeakEF 3.3 ± 1.9 vs. 5.0 ± 2.2L; p = 0.001). No 90-day mortality was observed in any group. Median follow-up was 12(1-47) months. CONCLUSION In carefully selected patients treated in a specialized center, tracheal or laryngotracheal resection after previous tracheal interventions provides comparable outcome to primary surgery.
Collapse
Affiliation(s)
- Alexis Slama
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Mohamed Zaatar
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Muhittin Demir
- Department of Otorhinolaryngology, University Medicine Essen, Essen, Germany
| | - Oezlem Okumus
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Stefan Mattheis
- Department of Otorhinolaryngology, University Medicine Essen, Essen, Germany
| | - Sandra Kampe
- Department of Anesthesiology, Ruhrlandklinik, University Medicine Essen, Essen, Germany.,Department of Anaesthesiology and Intensive Care Medicine, University Hospital Magdeburg, Magdeburg, Sachsen-Anhalt, Germany
| | - Kaid Darwiche
- Division of Interventional Pneumology, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, University Medicine Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| |
Collapse
|
7
|
Allen M, Spillinger A, Arianpour K, Johnson J, Johnson AP, Folbe AJ, Hotaling J, Svider PF. Tracheal Resection in the Management of Thyroid Cancer: An Evidence-Based Approach. Laryngoscope 2020; 131:932-946. [PMID: 32985692 DOI: 10.1002/lary.29112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Determine the effect of patient demographics and surgical approach on patient outcomes after tracheal resection in the management of thyroid cancer. STUDY DESIGN Systematic review and meta-analysis. METHODS Systematic review of literature was performed using PubMed, Embase, and Cochrane Library to identify patients with thyroid carcinoma who underwent tracheal resection. Pooled estimates for patient demographics, presenting findings, complications, and outcomes are determined using random-effects meta-analyses. RESULTS Ninety-six relevant studies encompassing 1,179 patients met inclusion criteria. Meta-analysis pooled rates of complications: 1.7% (confidence interval [CI] 0.8-2.5; P < .001; I2 = 1.85%) airway complications, 2.8% (CI 1.6-3.9; P < .001; I2 = 13.34%) bilateral recurrent laryngeal nerve paralysis, 2.2% (CI 1.2-3.1; P < .001; I2 = 6.72%) anastomotic dehiscence. Circumferential resection pooled estimates major complications, locoregional recurrence, distal recurrence, overall survival: 14.1% (CI 8.3-19.9; P < .001; I2 = 35.26%), 15% (CI 9.6-20.3; P < .001; I2 = 38.2%), 19.7% (CI 13.7-25.8; P < .001; I2 = 28.83%), 74.5% (CI 64.4-84.6; P < .001; I2 = 85.07%). Window resection estimates: 19.8% (CI 6.9-32.8; P < .001; I2 = 18.83%) major complications, 25.6% (CI 5.1-46.1; P < .014; I2 = 84.68%) locoregional recurrence, 15.6% (CI 9.7-21.5; P < .001; I2 = 0%) distal recurrence, 77.1% (CI 58-96.2; P < .001; I2 = 78.77%) overall survival. CONCLUSION Management of invasive thyroid carcinoma may require tracheal resection to achieve locoregional control. Nevertheless, postoperative complications are not insignificant, and therefore this risk cannot be overlooked when counseling patients perioperatively. Laryngoscope, 131:932-946, 2021.
Collapse
Affiliation(s)
- Meredith Allen
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | - Aviv Spillinger
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | | | - Jared Johnson
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Andrew P Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Medical School, Aurora, Colorado, U.S.A
| | - Adam J Folbe
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | - Jeffrey Hotaling
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.,Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Peter F Svider
- Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, New Jersey, U.S.A
| |
Collapse
|
8
|
Groth SS, Habermann EB, Massarweh NN. United States Administrative Databases and Cancer Registries for Thoracic Surgery Health Services Research. Ann Thorac Surg 2020; 109:636-644. [DOI: 10.1016/j.athoracsur.2019.08.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/18/2019] [Indexed: 12/20/2022]
|
9
|
Crabtree TD, Boffa DJ, Lobdell KW, Habib RH, Gaissert HA. The Society of Thoracic Surgeons General Thoracic Surgery Database: 2019 Update on Research. Ann Thorac Surg 2019; 108:1293-1298. [DOI: 10.1016/j.athoracsur.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/02/2019] [Indexed: 12/20/2022]
|
10
|
Reply. Ann Thorac Surg 2019; 108:1586. [PMID: 31653295 DOI: 10.1016/j.athoracsur.2019.04.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 11/23/2022]
|
11
|
Johnson RF, Eaviz N, Truelson JM, Day AT. Perioperative outcomes after tracheoplasty: A NSQIP analysis 2014-2016. Laryngoscope 2019; 130:1514-1519. [PMID: 31498450 DOI: 10.1002/lary.28280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/17/2019] [Accepted: 08/19/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Tracheoplasty or tracheal resection and are essential components of the care of patients with severe tracheal stenosis. We aimed to study the perioperative outcomes of patients after tracheoplasty or resection using a national surgical registry. METHODS We analyzed the 2014 to 2016 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participant use file for patients who underwent tracheal resection or tracheoplasty (CPT codes 31750, 31760, 31780, and 31781). We analyzed the perioperative outcomes including length of stay (LOS), dehiscence, unplanned reintubations, unplanned surgeries, and 30-day readmission rates. A random 4:1 sample of non-tracheoplasty patients served as the control group. RESULTS From 2014 to 2016, 126 patients underwent tracheoplasty. The median age was 56 years (IQR = 45-63). There were 93 (74%) females, 88 (70%) white, and 3.2% (4/126) Hispanic. The median LOS was 7 days (IQR = 5-10 days). Of these, 4.8% (6/126) developed wound infections and 3/126 (2.4%) developed wound dehiscence. Five out of 126 required unplanned reintubation (4.0%) and 16/126 (13%) had an unplanned reoperation. The 30-day unplanned readmission rate was 16% (20/126). The wound infection, unplanned intubations, and readmission rates were significantly higher (P < .005) than the control group. CONCLUSIONS The 30-day perioperative outcomes of adult patients undergoing tracheoplasty showed that adverse events are common, but severe adverse events such as death are rare. Continued research into risk mitigation among these patients is warranted. LEVEL OF EVIDENCE NA Laryngoscope, 130:1514-1519, 2020.
Collapse
Affiliation(s)
- Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Nathan Eaviz
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - John M Truelson
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| |
Collapse
|
12
|
Timman ST, Siddiqi S, Verhagen AFTM. The Tribulation of Tracheal Surgery. Ann Thorac Surg 2019; 108:1586. [PMID: 30910652 DOI: 10.1016/j.athoracsur.2019.02.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Simone T Timman
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Postbus 9101 (615), 6500 HB, Nijmegen, The Netherlands.
| | - Sailay Siddiqi
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Postbus 9101 (615), 6500 HB, Nijmegen, The Netherlands
| | - Ad F T M Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Postbus 9101 (615), 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
13
|
Laryngo-tracheal resections in the Nordic countries: an option for further centralization? Eur Arch Otorhinolaryngol 2019; 276:1545-1548. [PMID: 30888495 DOI: 10.1007/s00405-019-05384-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE We aimed to obtain information on the number of Nordic centers performing tracheal resections, crico-tracheal resections, and laryngo-tracheal reconstructions, as well as the patient volume and the standard regimens associated with these procedures. METHODS Consultants at all Departments of Otorhinolaryngology-Head and Neck Surgery (ORL-HNS, n = 22) and Thoracic Surgery (n = 21) in the five Nordic countries were invited (April 2018-January 2019) to participate in an online survey. RESULTS All 43 departments responded to the survey. Twenty departments declared to perform one or more of the three types of tracheal resections. At five hospitals, departments of ORL-HNS and Thoracic Surgery perform these operations in collaboration. Hence, one or more of the tracheal operations in question are carried out at 15 centers. The median annual number of tracheal operations per center is five (range 1-20). Great variations were found regarding contraindications (relative and absolute) for surgery, the use of guardian sterno-mental sutures (all patients, 33%; selected cases, 40% of centers), prophylactic antibiotic therapy (cefuroxime +/- metronidazole, penicillin +/- metronidazole, clindamycin, imipenem, or none), post-operative follow-up time (range: children: 3-120 months; adults: 0-60 months), and the performance of post-operative bronchoscopy. CONCLUSIONS Fifteen centers each perform a low number of annual operations with significant variations in the selection of patients and the clinical setup, which raises the question if a higher degree of collaboration and centralization would be warranted. We encourage Nordic transnational collaboration, pursuing alignment on central management issues, and establishment of a common prospective database for future tracheal resection surgery.
Collapse
|
14
|
Crabtree TD, Gaissert HA, Jacobs JP, Habib RH, Fernandez FG. The Society of Thoracic Surgeons General Thoracic Surgery Database: 2018 Update on Research. Ann Thorac Surg 2018; 106:1288-1293. [PMID: 30267695 DOI: 10.1016/j.athoracsur.2018.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Traves D Crabtree
- Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
| | - Henning A Gaissert
- Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey P Jacobs
- Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital and Florida Hospital for Children, St. Petersburg, Tampa, and Orlando, Florida
| | - Robert H Habib
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | | |
Collapse
|