Title

Outcome measures for pediatric laryngotracheal reconstruction: International consensus statement

Authors

Karthik Balakrishnan, Mayo Clinic
Douglas R. Sidell, Stanford University
Nancy M. Bauman, Childrens National Health System
Gaston F. Bellia-Munzon, General Hospital of Children Pedro de Elizalde
R. Paul Boesch, Mayo Clinic
Matthew Bromwich, University of Ottawa, Canada
Shelagh A. Cofer, Mayo Clinic
Cori Daines, The University of Arizona Health Sciences
Alessandro de Alarcon, Cincinnati Children's Hospital Medical Center
Nöel Garabedian, Hôpital Necker Enfants Malades
Catherine K. Hart, Cincinnati Children's Hospital Medical Center
Jonathan B. Ida, Northwestern University Feinberg School of Medicine
Nicolas Leboulanger, Hôpital Necker Enfants Malades
Peter B. Manning, St. Louis Children's Hospital
Deepak K. Mehta, Texas Children's Hospital Houston
Philippe Monnier, Centre Hospitalier Universitaire Vaudois
Charles M. Myer, Cincinnati Children's Hospital Medical Center
Jeremy D. Prager, University of Colorado Health Sciences Center
Diego Preciado, Childrens National Health System
Evan J. Propst, Hospital for Sick Children University of Toronto
Reza Rahbar, Children's Hospital Boston
John Russell, Our Lady's Hospital for Sick Children
Michael J. Rutter, Cincinnati Children's Hospital Medical Center
Briac Thierry, Hôpital Necker Enfants Malades
Dana M. Thompson, Northwestern University Feinberg School of Medicine
Michele Torre, IRCCS Istituto Giannina Gaslini - Ospedale Pediatrico
Patricio Varela, Universidad de Chile
Shyan Vijayasekaran, Princess Margaret Hospital for Children
David R. White, Medical University of South Carolina
Andre M. Wineland, University of Arkansas for Medical Sciences
Robert E. Wood, Cincinnati Children's Hospital Medical Center
Christopher T. Wootten, Monroe Carell Jr. Children's Hospital at Vanderbilt
Karen Zur, University of Pennsylvania Perelman School of Medicine

Document Type

Journal Article

Publication Date

1-1-2019

Journal

Laryngoscope

Volume

129

Issue

1

DOI

10.1002/lary.27445

Keywords

Airway reconstruction; consensus; Delphi; larynx; pediatric; stenosis; trachea

Abstract

© 2018 The American Laryngological, Rhinological and Otological Society, Inc. 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.

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