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. 2019 Jun;160(6):1065-1070.
doi: 10.1177/0194599818825471. Epub 2019 Feb 5.

Laryngotracheal Reconstruction in Adults Aged 60 Years and Older

Saad C Rehman  1   2 , Deborah X Xie  1   2 , James R Bekeny  3 , Alexander Gelbard  2   3 , Christopher T Wootten  2   3
Affiliations

Laryngotracheal Reconstruction in Adults Aged 60 Years and Older

Saad C Rehman et al. Otolaryngol Head Neck Surg. 2019 Jun.

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.

Keywords: airway reconstruction; cartilage graft; laryngotracheal reconstruction; laryngotracheal stenosis.

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