Outcome measures for pediatric laryngotracheal reconstruction: International consensus statement

Karthik Balakrishnan, Douglas R Sidell, Nancy M Bauman, Gaston F Bellia-Munzon, R Paul Boesch, Matthew Bromwich, Shelagh A Cofer, Cori Daines, Alessandro de Alarcon, Nöel Garabedian, Catherine K Hart, Jonathan B Ida, Nicolas Leboulanger, Peter B Manning, Deepak K Mehta, Philippe Monnier, Charles M Myer, Jeremy D Prager, Diego Preciado, Evan J PropstReza Rahbar, John Russell, Michael J Rutter, Briac Thierry, Dana M Thompson, Michele Torre, Patricio Varela, Shyan Vijayasekaran, David R White, Andre M Wineland, Robert E Wood, Christopher T Wootten, Karen Zur, Robin T Cotton

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Develop multidisciplinary and international consensus on patient, disease, procedural, and perioperative factors, as well as key outcome measures and complications, to be reported for pediatric airway reconstruction studies.

METHODS: Standard Delphi methods were applied. Participants proposed items in three categories: 1) patient/disease characteristics, 2) procedural/intraoperative/perioperative factors, and 3) outcome measures and complications. Both general and anatomic site-specific measures were elicited. Participants also suggested specific operations to be encompassed by this project. We then used iterative ranking and review to develop consensus lists via a priori Delphi consensus criteria.

RESULTS: Thirty-three pediatric airway experts from eight countries in North and South America, Europe, and Australia participated, representing otolaryngology (including International Pediatric Otolaryngology Group members), pulmonology, general surgery, and cardiothoracic surgery. Consensus led to inclusion of 19 operations comprising open expansion, resection, and slide procedures of the larynx, trachea, and bronchi as well as three endoscopic procedures. Consensus was achieved on multiple patient/comorbidity (10), disease/stenosis (7), perioperative-/intraoperative-/procedure-related (16) factors. Consensus was reached on multiple outcome and complication measures, both general and site-specific (8 general, 13 supraglottic, 15 glottic, 17 subglottic, 8 cervical tracheal, 12 thoracic tracheal). The group was able to clarify how each outcome should be measured, with specific instruments defined where applicable.

CONCLUSION: This consensus statement provides a framework to communicate results consistently and reproducibly, facilitating meta-analyses, quality improvement, transfer of information, and surgeon self-assessment. It also clarifies expert opinion on which patient, disease, procedural, and outcome measures may be important to consider in any pediatric airway reconstruction patient.

LEVEL OF EVIDENCE: 5 Laryngoscope, 129:244-255, 2019.

Original languageEnglish
Pages (from-to)244-255
Number of pages12
JournalLaryngoscope
Volume129
Issue number1
DOIs
Publication statusPublished - Jan 2019

Keywords

  • Child
  • Delphi Technique
  • Humans
  • Laryngoplasty/standards
  • Larynx/surgery
  • Otorhinolaryngologic Surgical Procedures/methods
  • Outcome Assessment, Health Care/methods
  • Pediatrics
  • Practice Guidelines as Topic
  • Reconstructive Surgical Procedures/methods
  • Reoperation
  • Trachea/surgery

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  • Cite this

    Balakrishnan, K., Sidell, D. R., Bauman, N. M., Bellia-Munzon, G. F., Boesch, R. P., Bromwich, M., Cofer, S. A., Daines, C., de Alarcon, A., Garabedian, N., Hart, C. K., Ida, J. B., Leboulanger, N., Manning, P. B., Mehta, D. K., Monnier, P., Myer, C. M., Prager, J. D., Preciado, D., ... Cotton, R. T. (2019). Outcome measures for pediatric laryngotracheal reconstruction: International consensus statement. Laryngoscope, 129(1), 244-255. https://doi.org/10.1002/lary.27445