Postoperative management of pediatric patients undergoing single-stage laryngotracheal reconstruction in the United States: A survey of ASPO members

Introduction: The postoperative management of single-stage laryngotracheal reconstruction (ssLTR) plays a significant role in the surgery's outcomes. The relatively prolonged period in which the child remains intubated and sedated to allow graft healing may be complicated by pulmonary sequelae, airway obstruction, withdrawal symptoms, and eventually failed extubation. This study aims to assess post-ssLTR practices among pediatric otolaryngologists. Method: An electronic cross-sectional survey was distributed to the American Society of Pediatric Otolaryngology (ASPO) members to elucidate current protocols in post-ssLTR practice in the United States. Results: Eighty-six responses were recorded. A majority (60 %; n = 50) reported performing fewer than five ssLTRs per year. The mean time to bronchoscopy following ssLTR was postoperative day 8+3 for ssLTR with a posterior graft and postoperative day 7+3 without a posterior graft. Most practitioners reported avoiding paralytics (61 %, n = 44) unless the desired level of sedation could not be achieved. Most providers utilized prepyloric feeding via a nasogastric or gastrostomy tube (n = 50, 72 %). A total of 70 % (n = 49) of respondents use a single medication for acid suppression, whereas 21 % (n = 15) reported dual-acid suppression whether the patient was diagnosed with gastroesophageal reflux prior to surgery or not, regardless of feeding route. Nebulized agents were routinely used, with normal saline (43 %; n = 36) being the most reported agent. Conclusion: The postoperative management after ssLTR varies greatly among pediatric otolaryngologists due to a lack of evidence-based data to support one protocol over the other. Multi-institutional studies should be considered to evaluate current protocols and improve postoperative care.