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Patel R, Dhanda AK, Georges K, Cohen DA, Patel P, Eloy JA. Length of Stay in Patients Undergoing Tracheoplasty: A NSQIP Study. Laryngoscope 2022. [PMID: 36214517 DOI: 10.1002/lary.30424] [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: 04/18/2022] [Revised: 08/21/2022] [Accepted: 09/15/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prolonged length of stay (LOS) has been associated with increased morbidity and resource utilization in various surgical procedures. We aim to determine factors associated with increased hospital stay in patient undergoing tracheoplasty. METHODS The 2012-2018 National Surgical Quality Improvement Program (NSQIP) database was queried for patients undergoing tracheoplasty. Patient LOS was the primary clinical outcome. A LOS >75th percentile was considered as prolonged and was utilized for bivariate analysis of demographic, comorbidity, and operative characteristics. LOS was utilized as a continuous variable for multivariate linear regression analysis. RESULTS A total of 252 patients were queried. The majority of patients were female (67.5%), white (82.4%), and over the age of 65 (77.0%). Patients had a median LOS of 7 days with the 75th percentile cutoff being defined at 10 days. On bivariate analysis of associated comorbidities, patients with prolonged LOS were more commonly obese (72.4% vs. 53.1%, p = 0.009), diabetic (37.9% vs. 16.5%, p < 0.001), dyspneic (58.6% vs. 40.7%, p = 0.016), and had chronic steroid use (25.9% vs. 12.9%, p = 0.018). Multivariable logistic regression analysis demonstrated significant associations between prolonged LOS and both chronic obstructive pulmonary disorder (COPD) (OR: 3.43, p = 0.020) and chronic steroid use (OR: 3.81, p = 0.018). CONCLUSIONS This study elucidates factors associated with prolonged LOS in patients undergoing tracheoplasty. Patients with COPD and chronic steroid use were significantly associated with prolonged LOS. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Rushi Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Aatin K Dhanda
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Kirolos Georges
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - David A Cohen
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Prayag Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Otolaryngology and Facial Plastic Surgery, Cooperman Barnabas Medical Center - RWJ Barnabas Health, Livingston, New Jersey, USA
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Frejo L, Grande DA. 3D-bioprinted tracheal reconstruction: an overview. Bioelectron Med 2019; 5:15. [PMID: 32232104 PMCID: PMC7098220 DOI: 10.1186/s42234-019-0031-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/16/2019] [Indexed: 11/10/2022] Open
Abstract
Congenital tracheomalacia and tracheal stenosis are commonly seen in premature infants. In adulthood, are typically related with chronic obstructive pulmonary disease, and can occur secondarily from tracheostomy, prolong intubation, trauma, infection and tumors. Both conditions are life-threatening when not managed properly. There are still some surgical limitations for certain pathologies, however tissue engineering is a promising approach to treat massive airway dysfunctions. 3D-bioprinting have contributed to current preclinical and clinical efforts in airway reconstruction. Several strategies have been used to overcome the difficulty of airway reconstruction such as scaffold materials, construct designs, cellular types, biologic components, hydrogels and animal models used in tracheal reconstruction. Nevertheless, additional long-term in vivo studies need to be performed to assess the efficacy and safety of tissue-engineered tracheal grafts in terms of mechanical properties, behavior and, the possibility of further stenosis development.
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Affiliation(s)
- Lidia Frejo
- Orthopaedic Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030 USA
- Division of Otolaryngology and Communicative Disorders-Pediatric Otolaryngology, Long Island Jewish Medical Center New Hyde Park, New York, USA
| | - Daniel A. Grande
- Orthopaedic Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030 USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Hamilton NJI, Birchall MA. Tissue-Engineered Larynx: Future Applications in Laryngeal Cancer. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017; 5:42-48. [PMID: 28367360 PMCID: PMC5357481 DOI: 10.1007/s40136-017-0144-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose of Review This article reviews the latest developments in tissue engineering for the larynx with a specific focus on the treatment of laryngeal cancer. Recent Findings Challenges in tissue engineering a total larynx can be divided into scaffold design, methods of re-mucosalization, and how to restore laryngeal function. The literature described a range of methods to deliver a laryngeal scaffold including examples of synthetic, biomimetic, and biological scaffolds. Methods to regenerate laryngeal mucosa can be divided into examples that use a biological dressing and those that engineer a new mucosal layer de novo. Studies aiming to restore laryngeal function have been reported, but to date, the optimum method for achieving this as part of a total laryngeal transplant is yet to be determined. Summary There is great potential for tissue engineering to improve the treatments available for laryngeal cancer within the next 10 years. A number of challenges exist however and advances in restoring function must keep pace with developments in scaffold design.
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Lewis S, Earley M, Rosenfeld R, Silverman J. Systematic review for surgical treatment of adult and adolescent laryngotracheal stenosis. Laryngoscope 2016; 127:191-198. [DOI: 10.1002/lary.26151] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Sean Lewis
- Department of Otolaryngology; State University of New York Downstate Medical Center; Brooklyn New York U.S.A
| | - Marisa Earley
- Department of Otolaryngology; State University of New York Downstate Medical Center; Brooklyn New York U.S.A
| | - Richard Rosenfeld
- Department of Otolaryngology; State University of New York Downstate Medical Center; Brooklyn New York U.S.A
| | - Joshua Silverman
- Department of Otolaryngology; State University of New York Downstate Medical Center; Brooklyn New York U.S.A
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Yagudin RK, Yagudin KF. [The long-term results of the application of the polypropylene mesh for the plastic correction of extensive laryngo-tracheostomas]. Vestn Otorinolaringol 2016; 81:67-69. [PMID: 27213661 DOI: 10.17116/otorino201681267-69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of the present study was to estimate the long-term results of the closure of large laryngeal and tracheal stomas with the use of the polypropylene mesh. The study included 33 adult patients presenting with extensive laryngeal and tracheal stomas. A total of 34 surgical interventions were performed for alloplastic correction of these defects. The complete closure of the tracheal and laryngeal defects with the incorporation of the prosthesis and restoration of respiration was achieved in 88.2% of the alloplastic procedures. The long-term follow-up of the treated patients (median: 75 months) failed to reveal any signs of mesh rejection. Moreover, none of the patients reported an appreciable feeling of discomfort at the site of mesh localization. Thus, the results of the study indicate that the alloplastic correction of laryngeal and tracheal stomas with the implantation of the modern mesh prostheses from polypropylene monofilaments provides the safe and reliable alternative to autoplastic surgery. Low rigidity of the modern prosthetic meshes ensures good immediate results of implant survival in the absence of long-term complications associated with the durable presence of the polypropylene mesh on the neck.
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Affiliation(s)
- R K Yagudin
- Kazan State Medical Academy, Russian Ministry of Health, Kazan, Russian Federation, 420012
| | - K F Yagudin
- Municipal Polyclinic No 8, Kazan, Russian Federation, 420075
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Goldstein TA, Smith BD, Zeltsman D, Grande D, Smith LP. Introducing a 3-dimensionally Printed, Tissue-Engineered Graft for Airway Reconstruction. Otolaryngol Head Neck Surg 2015; 153:1001-6. [DOI: 10.1177/0194599815605492] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/21/2015] [Indexed: 12/19/2022]
Abstract
Objective: To use 3-dimensional (3D) printing and tissue engineering to create a graft for laryngotracheal reconstruction (LTR). Study Design: In vitro and in vivo pilot animal study. Setting: Large tertiary care academic medical center. Subjects and Methods: A 3D computer model of an anterior LTR graft was designed. That design was printed with polylactic acid on a commercially available 3D printer. The scaffolds were seeded with mature chondrocytes and collagen gel and cultured in vitro for up to 3 weeks. Scaffolds were evaluated in vitro for cell viability and proliferation. Anterior graft LTR was performed on 9 New Zealand white rabbits with the newly created scaffolds. Three animals were sacrificed at each time point (4, 8, and 12 weeks). The in vivo graft sites were assessed via bronchoscopy and histology. Results: The in vitro cell proliferation assay demonstrated initial viability of 87.5%. The cells proliferated during the study period, doubling over the first 7 days. Histology revealed that the cells retained their cartilaginous properties during the 21-day study period. In vivo testing showed that all animals survived for the duration of the study. Bronchoscopy revealed a well-mucosalized tracheal lumen with no evidence of scarring or granulation tissue. Histology indicated the presence of newly formed cartilage in the region where the graft was present. Conclusions: Our results indicate that it is possible to produce a custom-designed, 3D-printed, tissue-engineered graft for airway reconstruction.
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Affiliation(s)
- Todd A. Goldstein
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
- Orthopaedic Research Laboratory, Feinstein Institute of Medical Research, Manhasset, New York, USA
| | - Benjamin D. Smith
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
- Orthopaedic Research Laboratory, Feinstein Institute of Medical Research, Manhasset, New York, USA
| | - David Zeltsman
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
- Department of Cardiovascular and Thoracic Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
| | - Daniel Grande
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
- Orthopaedic Research Laboratory, Feinstein Institute of Medical Research, Manhasset, New York, USA
| | - Lee P. Smith
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
- Division of Pediatric Otolaryngology, Steven and Alexandra Cohen Children’s Medical Center, New Hyde Park, New York, USA
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Rieger E, Dupret-Bories A, Salou L, Metz-Boutigue MH, Layrolle P, Debry C, Lavalle P, Vrana NE. Controlled implant/soft tissue interaction by nanoscale surface modifications of 3D porous titanium implants. NANOSCALE 2015; 7:9908-9918. [PMID: 25967094 DOI: 10.1039/c5nr01237f] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Porous titanium implants are widely employed in the orthopaedics field to ensure good bone fixation. Recently, the use of porous titanium implants has also been investigated in artificial larynx development in a clinical setting. Such uses necessitate a better understanding of the interaction of soft tissues with porous titanium structures. Moreover, surface treatments of titanium have been generally evaluated in planar structures, while the porous titanium implants have complex 3 dimensional (3D) architectures. In this study, the determining factors for soft tissue integration of 3D porous titanium implants were investigated as a function of surface treatments via quantification of the interaction of serum proteins and cells with single titanium microbeads (300-500 μm in diameter). Samples were either acid etched or nanostructured by anodization. When the samples are used in 3D configuration (porous titanium discs of 2 mm thickness) in vivo (in subcutis of rats for 2 weeks), a better integration was observed for both anodized and acid etched samples compared to the non-treated implants. If the implants were also pre-treated with rat serum before implantation, the integration was further facilitated. In order to understand the underlying reasons for this effect, human fibroblast cell culture tests under several conditions (directly on beads, beads in suspension, beads encapsulated in gelatin hydrogels) were conducted to mimic the different interactions of cells with Ti implants in vivo. Physical characterization showed that surface treatments increased hydrophilicity, protein adsorption and roughness. Surface treatments also resulted in improved adsorption of serum albumin which in turn facilitated the adsorption of other proteins such as apolipoprotein as quantified by protein sequencing. The cellular response to the beads showed considerable difference with respect to the cell culture configuration. When the titanium microbeads were entrapped in cell-laden gelatin hydrogels, significantly more cells migrated towards the acid etched beads. In conclusion, the nanoscale surface treatment of 3D porous titanium structures can modulate in vivo integration by the accumulative effect of the surface treatment on several physical factors such as protein adsorption, surface hydrophilicity and surface roughness. The improved protein adsorption capacity of the treated implants can be further exploited by a pre-treatment with autologous serum to render the implant surface more bioactive. Titanium microbeads are a good model system to observe these effects in a 3D microenvironment and provide a better representation of cellular responses in 3D.
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Affiliation(s)
- Elisabeth Rieger
- Institut National de la Santé et de la Recherche Médicale, INSERM Unité 1121, 11 Rue Humann, 67000 Strasbourg, France
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Tan A, Cheng S, Cui P, Gao P, Luo J, Fang C, Zhao Z. Experimental study on an airway prosthesis made of a new metastable β-type titanium alloy. J Thorac Cardiovasc Surg 2011; 141:888-94. [DOI: 10.1016/j.jtcvs.2010.09.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 08/25/2010] [Accepted: 09/10/2010] [Indexed: 11/30/2022]
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Liu XK, Zhang Q, Li Q, Liu WW, Li H, Zeng ZY, Guo ZM. Laryngeal framework reconstruction using titanium mesh in glottic cancer after frontolateral vertical partial laryngectomy. Laryngoscope 2011; 120:2197-202. [PMID: 20824791 DOI: 10.1002/lary.21103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate the feasibility and efficacy of laryngeal framework reconstruction using titanium mesh in patients with glottic cancer after frontolateral vertical partial laryngectomy. STUDY DESIGN Prospective study. METHODS Defect of laryngeal framework, caused by frontolateral vertical partial laryngectomy in nine patients with T2 or T3 squamous cell carcinoma of glottic, were reconstructed with titanium mesh from 2007 to 2009. Computed tomography (CT) and fiberscopic examinations were performed at two weeks and three months postoperatively. RESULTS No aspiration and laryngeal stenosis was observed in the nine patients. CT scanning showed that titanium mesh was fastened well without displacement and deformity and that there was no laryngeal stenosis. Fiberscopic inspection showed that the larynx lumen was maintained well without stricture, shrinkage, and necrosis. No titanium mesh was exposed to the larynx lumen. CONCLUSIONS Titanium mesh was a good alternative for reconstruction of the laryngeal framework. It provided adequate structural support to maintain airway patency.
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Affiliation(s)
- Xue-Kui Liu
- State Key Laboratory of Oncology in South China, Department of Head and Neck Surgery, Cancer Center, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
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Daneshi A, Mohammadi S, Hassannia F. Delayed laryngotracheal reconstruction with titanium plate: report of 10 cases. J Voice 2010; 24:755-7. [PMID: 20083376 DOI: 10.1016/j.jvoice.2009.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Accepted: 10/09/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Subglottic stenosis is congenital or acquired narrowing of subglottic area. The management of subglottic stenosis is still a serious surgical challenge. Although different surgical techniques are accomplished to manage the condition, no standard treatment has been presented yet. STUDY DESIGN Titanium mesh was used in the reconstruction of the anterior laryngotracheal wall in 10 tracheostomized patients with laryngotracheal stenosis because of prolonged intubation. The anterior laryngotracheal wall was split, followed by excision of scar tissue. After several weeks, in a second-stage performance, the titanium plate was fixed at the split edges. RESULTS Finally, all the patients were decanulated. However, one patient developed respiratory distress because of granulation tissue and underwent a second trial of decanulation. In one patient, the titanium plate extruded.
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Affiliation(s)
- Ahmad Daneshi
- Department of Otolaryngology and Head and Neck Surgery, Iran University of Medical Science, Hazrate Rasoul hospital, Tehran, Iran
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Use of titanium mesh in laryngotracheal reconstruction: an experimental study on rabbits. Eur Arch Otorhinolaryngol 2010; 267:1247-53. [PMID: 20069310 DOI: 10.1007/s00405-009-1189-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 12/18/2009] [Indexed: 10/20/2022]
Abstract
Titanium mesh may be an alternative material to be used in laryngotracheal reconstruction. Twenty New Zealand rabbits were divided into two groups. Group A underwent laryngotracheoplasty with titanium mesh-buccal mucosa-muscle complex, and Group B received auricular cartilage grafts. All animals survived without complications. The animals were killed at 60 days, and laryngotracheal regions were evaluated. There was no subglottic collapse at physiologic and supraphysiologic negative airway pressures in Group A and mild-moderate collapse in Group B. Macroscopically the average antero-posterior and lateral diameters were not statistically different among two groups. Light microscopic examination revealed no fibrosis, necrosis or new cartilage formation in both groups. Inflammation and granulation were more pronounced in Group A. The lumens in both groups were moderately obstructed. Reconstruction of the upper airway with titanium mesh may be used in very selected cases where autologous grafting materials are inadequate and unsatisfactory.
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Williamson JP, Phillips MJ, Hillman DR, Eastwood PR. Managing obstruction of the central airways. Intern Med J 2009; 40:399-410. [PMID: 19849741 DOI: 10.1111/j.1445-5994.2009.02113.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer is the most common cause of cancer death in Australia, Europe and the USA. Up to 20-30% of these cancers eventually affect the central airways and result in reduced quality of life, dyspnoea, haemoptysis, post-obstructive pneumonia and ultimately death. Non-malignant processes may also lead to central airway obstruction and can have similar symptoms. With the development of newer technologies, the last 20 years have seen the emergence of the field of interventional pulmonology to deal specifically with the diagnosis and management of thoracic malignancy, including obstruction of the central airways. This review discusses the pathology, pre-procedure work-up and management options for obstructing central airway lesions. Several treatment modalities exist for dealing with endobronchial pathology with local availability and expertise guiding choice of treatment. While the literature lacks large, multicentre, randomized studies defining the optimal management strategy for a given problem, there is growing evidence from numerous case studies of improved physiology, of quality of life and possibly of survival with modern interventional techniques.
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Affiliation(s)
- J P Williamson
- Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Western Australia 6009, Australia.
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