Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, USA.
Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, USA.
Int J Pediatr Otorhinolaryngol. 2021 Jul;146:110760. doi: 10.1016/j.ijporl.2021.110760. Epub 2021 May 11.
We aimed to assess procedural trends for tracheostomy placement in the management of children with subglottic stenosis. We hypothesize that with increased use of less invasive airway interventions for subglottic stenosis, tracheostomy may be performed less frequently over time.
Data were collected from the Kids' Inpatient Database (KID) for pediatric discharges with an admission diagnosis of subglottic stenosis (Stenosis of larynx: ICD-9 code 478.74) from across the United States for years 2000, 2003, 2006, 2009, and 2012. The number of overall procedures and specific airway procedures including tracheostomy (ICD-9-CM codes 31.1, 31.29) were evaluated.
A weighted estimate of 18,124 pediatric discharges with a diagnosis of subglottic stenosis were identified. Overall, there was an increase in the mean number of procedures performed during hospitalization from 2000 to 2012 (p < 0.001); however, there was a decrease in the proportion of children undergoing tracheostomy placement (p < 0.001).
Trends over the past decade from a US national database have revealed decreasing tracheostomy placement in hospitalized pediatric patients with subglottic stenosis. This may be due to a change in paradigm with increased use of less invasive, possibly endoscopic, treatment in this patient population. Further investigations may be helpful to identify management paradigms to optimize care in order to help avoid tracheostomy placement.
评估儿童声门下狭窄管理中气管切开术的手术趋势。我们假设，随着声门下狭窄的气道介入治疗方法越来越少，气管切开术的频率可能会随着时间的推移而降低。
从美国全国范围的儿童住院患者数据库（KID）中收集了数据，这些患者的入院诊断为声门下狭窄（喉狭窄：ICD-9 编码 478.74），时间跨度为 2000 年、2003 年、2006 年、2009 年和 2012 年。评估了总手术次数和特定气道手术（包括气管切开术：ICD-9-CM 编码 31.1、31.29）的数量。
确定了 18124 例诊断为声门下狭窄的儿科住院患者的加权估计值。总体而言，住院期间手术次数的平均值从 2000 年到 2012 年有所增加（p<0.001）；然而，接受气管切开术的儿童比例却有所下降（p<0.001）。
过去十年来自美国国家数据库的趋势显示，住院治疗的儿童声门下狭窄患者的气管切开术放置量减少。这可能是由于该患者群体中使用了较少侵入性、可能是内镜治疗的方法，从而改变了治疗模式。进一步的研究可能有助于确定管理模式，以优化护理，从而有助于避免气管切开术的放置。
