Comparison of early and late extubation following single-stage anterior laryngotracheoplasty

Objective: To compare the outcomes of early versus late extubation after primary single-stage anterior laryngotracheoplasty (LTP) using thyroid ala graft performed at our tertiary care academic children's hospital. Methods: Twenty-five pediatric patients underwent single-stage anterior LTP using thyroid ala grafts between September 2002 and June 2009. Initial trials of extubation were attempted in 15 patients on or prior to postoperative day (POD) 2 and in 10 patients on or after POD 3. The main outcome measures analyzed in this retrospective comparison study were complication rate, length of hospitalization, reintubation during hospitalization, need for additional airway procedures, and overall decannulation rate. Results: The rates of various complications in each group were not statistically significant, with the exception of methadone taper. No patients in the early extubation group and four patients in the late extubation group required methadone taper [p< 0.05]. The average length of hospitalization after extubation for the early extubation group was 16.5 days [SD. = 14.0] and 14.6 days [SD. = 7.7] for the late extubation group [p> 0.05]. Six patients (40%) in the early extubation group and two (20%) in the late extubation group needed reintubation at some point during hospitalization post-LTP [p> 0.05]. Ten patients [66.7%] in the early extubation group and eight [80%] in the late extubation group required additional airway procedures post-LTP [p> 0.05]. Ultimately, 12 (80%) of the early extubation group and nine (90%) of the late extubation group were successfully decannulated at the time of most recent follow-up [p> 0.05]. Conclusions: The differences in length of hospitalization, need for additional procedures, reintubation during hospitalization and overall decannulation rate between the early and late extubation groups after single-stage anterior LTP with thyroid ala graft were not statistically significant. Methadone taper was the only complication that was statistically significantly higher in the late extubation group.