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Article ; Online: Clinical Conundrum: An Unusual Case of Persistent Dyspnea and Eructation.

Dhar, Sarit / Deane, Janis / Chorney, Stephen R / Dhar, Shumon I

2023 Volume 39, Issue 1, Page(s) 159–162

MeSH term(s)	Humans ; Eructation ; Dyspnea/diagnosis ; Dyspnea/etiology
Language	English
Publishing date	2023-05-25
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	632764-3
ISSN	1432-0460 ; 0179-051X
ISSN (online)	1432-0460
ISSN	0179-051X
DOI	10.1007/s00455-023-10593-y
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Zs.A 2130: Show issues

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Article ; Online: Economic Evaluation of Pediatric Tracheostomy: A Cost of Illness Analysis.

Zhang, Jinghan / Liu, Palmila / Narayanan, Ajay M / Chorney, Stephen R / Kou, Yann-Fuu / Johnson, Romaine F

OTO open

2024 Volume 8, Issue 1, Page(s) e108

Abstract: Objective: This study aimed to determine the direct costs of pediatric tracheostomy care within a health care system.: Study design: Prospective analysis.: Setting: Academic children's hospital.: Methods: Costs associated with caring for ... ...

Abstract	Objective: This study aimed to determine the direct costs of pediatric tracheostomy care within a health care system. Study design: Prospective analysis. Setting: Academic children's hospital. Methods: Costs associated with caring for pediatric tracheostomy patients under 18 years were analyzed between 2015 and 2021. Direct costs were calculated using the Medicare/Medicaid charges-to-costs ratio for various visit types. Costs were estimated using generalized linear equations, accounting for confounders. Results: A total of 297 children underwent tracheostomy at a median age of 0.94 years. The median follow-up was 2.5 years, resulting in 13,966 visits (mean = 41). The total cost was $321 million. The initial admission accounted for 72% ($231 million) of costs while other inpatient admissions added 24% ($78 million). Emergency department, observation, and outpatient visits comprised 4% of costs. The length of stay (LOS) was the primary cost driver for inpatient visits. Each additional hospital day increased costs by roughly $1195, and each extra admission added about $130,223 after adjusting for confounders. Respiratory failure and infections were the primary reasons for 67% of subsequent admissions. Conclusion: Pediatric tracheostomy care generated over $300 million in direct costs over 5 years. Inpatient stays constituted 96% of these costs, with the LOS being a major factor. To reduce direct health expenditures for these patients, the focus should be on minimizing admissions.
Language	English
Publishing date	2024-01-17
Publishing country	United States
Document type	Journal Article
ISSN	2473-974X
ISSN (online)	2473-974X
DOI	10.1002/oto2.108
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Article ; Online: Multidisciplinary Pediatric Tracheostomy Teams.

Kou, Yann-Fuu / Chorney, Stephen R / Johnson, Romaine F

Otolaryngologic clinics of North America

2022 Volume 55, Issue 6, Page(s) 1195–1203

Abstract: Advances in neonatal and pediatric critical care have resulted in a growing population of medically complex children with a tracheostomy. These children are vulnerable to adverse events from underlying comorbidities, risks of tracheostomy, equipment ... ...

Abstract	Advances in neonatal and pediatric critical care have resulted in a growing population of medically complex children with a tracheostomy. These children are vulnerable to adverse events from underlying comorbidities, risks of tracheostomy, equipment malfunction, and caregiver inexperience. Multidisciplinary tracheostomy teams have emerged as effective initiatives to address these patient safety concerns. Improvements in quality metrics and clinical outcomes can occur after implementation of a multidisciplinary tracheostomy team. This review provides updates on the evidence for multidisciplinary pediatric tracheostomy teams and offers perspectives on the future direction of these programs.
MeSH term(s)	Infant, Newborn ; Child ; Humans ; Tracheostomy/adverse effects ; Quality Improvement ; Patient Safety ; Critical Care ; Comorbidity
Language	English
Publishing date	2022-10-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	417489-6
ISSN	1557-8259 ; 0030-6665
ISSN (online)	1557-8259
ISSN	0030-6665
DOI	10.1016/j.otc.2022.07.005
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Zs.B 183: Show issues

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Article ; Online: Surgical Outcomes by Early Airway Endoscopy Findings after Pediatric Staged Laryngotracheoplasty.

Dabbous, Helene / Chorney, Stephen R / Johnson, Romaine F / Kou, Yann-Fuu

The Laryngoscope

2023 Volume 134, Issue 2, Page(s) 963–967

Abstract: Objectives: To determine how initial postoperative airway endoscopy findings after stent removal predict successful decannulation in children undergoing double-staged laryngotracheoplasty (dsLTP). Secondary objectives assessed timing of decannulation ... ...

Abstract	Objectives: To determine how initial postoperative airway endoscopy findings after stent removal predict successful decannulation in children undergoing double-staged laryngotracheoplasty (dsLTP). Secondary objectives assessed timing of decannulation and number of endoscopic interventions needed after dsLTP. Methods: A case series with chart review included children who underwent dsLTP at a tertiary children's hospital between 2008 and 2021. Rates of decannulation, time to decannulation, and number of interventions after dsLTP were recorded for children with high- or low-grade stenosis at the first bronchoscopy after stent removal. Results: Of the 65 children who were included, 88% had high-grade stenosis and 98% had a preoperative tracheostomy. Successful decannulation happened in 74% of the children, and 44% of the children were decannulated within 12 months of surgery. For children with low-grade stenosis at the first endoscopy after stent removal, 84% were successfully decannulated compared with 36% of the children with high-grade stenosis (p = 0.001). After dsLTP, children with high-grade stenosis required 7.5 interventions (SD: 3.3) compared with 4.0 interventions (SD: 3.0) for children with low-grade stenosis (p < 0.001). Decannulated children with high-grade stenosis necessitated more endoscopic procedures (7.0 vs. 3.7, p = 0.02). Time to decannulation was similar between children with high- and low-grade early postoperative stenosis (21.9 vs. 17.8 months, p = 0.63). Conclusions: Higher grade stenosis identified on the first airway endoscopy after suprastomal stent removal is correlated with lower decannulation rates and more postoperative endoscopic interventions. Although time to decannulation was not impacted by early stenosis grade, surgeons might utilize these early airway findings to counsel families and prognosticate possible surgical success. Level of evidence: 4 Laryngoscope, 134:963-967, 2024.
MeSH term(s)	Child ; Humans ; Infant ; Constriction, Pathologic/surgery ; Laryngostenosis/surgery ; Laryngoplasty ; Endoscopy ; Tracheostomy ; Treatment Outcome ; Retrospective Studies
Language	English
Publishing date	2023-07-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.30875
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Ul II Zs.82: Show issues

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Article ; Online: A Pediatric Tracheostomy Scorecard: A Quality Improvement Tool for Comparative Analysis.

Kim, Jenny / Chorney, Stephen R / Kou, Yann-Fuu / Dabbous, Helene / Johnson, Romaine F

The Laryngoscope

2023 Volume 133, Issue 8, Page(s) 1815–1817

MeSH term(s)	Humans ; Child ; Tracheostomy ; Quality Improvement ; Benchmarking
Language	English
Publishing date	2023-05-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.30746
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Ul II Zs.82: Show issues

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Article ; Online: Reducing Pediatric Tracheostomy Wound Complications: An Evidence-Based Literature Review.

Baker, Lindsay R / Chorney, Stephen R

Advances in skin & wound care

2020 Volume 33, Issue 6, Page(s) 324–328

Abstract: Objective: To discuss prevention strategies that can mitigate the frequency of tracheostomy-related wound complications.: Data sources: A systematic literature review of PubMed between 2010 and 2019.: Study selection: Full-text articles written in ...

Abstract	Objective: To discuss prevention strategies that can mitigate the frequency of tracheostomy-related wound complications. Data sources: A systematic literature review of PubMed between 2010 and 2019. Study selection: Full-text articles written in English language and studying human participants younger than 18 years. Data extraction: The primary outcome was the rate of tracheostomy-related skin complications after implementation of a given intervention. Secondary outcomes included rates of accidental decannulation or other complications. Data synthesis: A total of 348 studies were identified and 6 met inclusion criteria. There were 1,607 children included with interventions designed to reduce peristomal and cervical wound complications in 1,174 (73.1%). Strategies considered safe and effective included protective skin barriers, reducing prolonged pressure, and early wound identification protocols. Conclusions: Wound complications after pediatric tracheostomy can be reduced using a multifaceted approach by providers committed to making skin care a priority.
MeSH term(s)	Adolescent ; Child ; Child, Preschool ; Cicatrix/etiology ; Cicatrix/prevention & control ; Humans ; Infant ; Infant, Newborn ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Surgical Wound Dehiscence/etiology ; Surgical Wound Infection/etiology ; Surgical Wound Infection/prevention & control ; Tracheal Diseases/etiology ; Tracheal Diseases/prevention & control ; Tracheostomy/adverse effects ; Tracheostomy/methods
Language	English
Publishing date	2020-05-13
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	2012792-3
ISSN	1538-8654 ; 1527-7941
ISSN (online)	1538-8654
ISSN	1527-7941
DOI	10.1097/01.ASW.0000661808.51766.9a
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Zs.A 3164: Show issues

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Article ; Online: Adenoidectomy Without Tonsillectomy for Pediatric Obstructive Sleep Apnea.

Chorney, Stephen R / Zur, Karen B

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery

2020 Volume 164, Issue 5, Page(s) 1100–1107

Abstract: Objective: The primary objective was to determine if obstructive sleep apnea (OSA) can improve after adenoidectomy.: Study design: Case series with chart review.: Setting: Tertiary children's hospital between 2016 and 2018.: Methods: The study ... ...

Abstract	Objective: The primary objective was to determine if obstructive sleep apnea (OSA) can improve after adenoidectomy. Study design: Case series with chart review. Setting: Tertiary children's hospital between 2016 and 2018. Methods: The study included children under 3.5 years with small (1+ or 2+) palatine tonsils, large (3+ or 4+) adenoids, and documented OSA on polysomnogram (PSG). Results: Seventy-one children were included. Age at adenoidectomy was 2.0 years (95% CI, 1.8-2.2) and 71.8% were male. Mean follow-up was 2.5 years (95% CI, 2.3-2.7). Twenty-six children (36.6%) obtained a repeat PSG at a mean of 9.7 months (95% CI, 6.3-13.2) after adenoidectomy. Among those with a postoperative PSG, apnea-hypopnea index decreased in 77.0% (mean, -3.2 events/h; 95% CI, -14.1 to 7.6), and the proportion with moderate to severe OSA decreased from 65.4% to 30.8% ( Conclusion: Adenoidectomy may improve OSA in young children with large adenoids and small tonsils. However, younger age predicted the need for subsequent tonsillectomy. Prospective studies with additional PSG data are necessary to corroborate these findings.
MeSH term(s)	Adenoidectomy ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Sleep Apnea, Obstructive/surgery ; Tonsillectomy
Language	English
Publishing date	2020-09-22
Publishing country	England
Document type	Journal Article
ZDB-ID	392085-9
ISSN	1097-6817 ; 0161-6439 ; 0194-5998
ISSN (online)	1097-6817
ISSN	0161-6439 ; 0194-5998
DOI	10.1177/0194599820955172
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Ul II Zs.83/a: Show issues

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Article ; Online: Assessment of socioeconomic disadvantage in laryngotracheoplasty outcomes among pediatric patients.

Kou, Yann-Fuu / Teplitzky, Taylor / Johnson, Romaine F / Chorney, Stephen R

International journal of pediatric otorhinolaryngology

2022 Volume 162, Page(s) 111326

MeSH term(s)	Child ; Constriction, Pathologic ; Female ; Humans ; Infant ; Laryngostenosis/surgery ; Male ; Postoperative Complications/epidemiology ; Retrospective Studies ; Socioeconomic Factors ; Tracheal Stenosis/surgery ; Treatment Outcome
Language	English
Publishing date	2022-09-22
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	754501-0
ISSN	1872-8464 ; 0165-5876
ISSN (online)	1872-8464
ISSN	0165-5876
DOI	10.1016/j.ijporl.2022.111326
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Zs.A 1507: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 134: Show issues

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Article: Tracheal A-frame deformity and suprastomal collapse after pediatric tracheostomy.

Suresh, Rishi / Dabbous, Helene / Alahari, Swapnika / Kou, Yann-Fuu / Johnson, Romaine F / Chorney, Stephen R

Laryngoscope investigative otolaryngology

2023 Volume 9, Issue 1, Page(s) e1202

Abstract: Objectives: To determine the incidence of A-frame deformity and suprastomal collapse after pediatric tracheostomy.: Study design: Retrospective cohort.: Methods: All patients (<18 years) that had a tracheostomy placed at a tertiary institution ... ...

Abstract	Objectives: To determine the incidence of A-frame deformity and suprastomal collapse after pediatric tracheostomy. Study design: Retrospective cohort. Methods: All patients (<18 years) that had a tracheostomy placed at a tertiary institution between 2015 and 2020 were included. Children without a surveillance bronchoscopy at least 6 months after tracheostomy were excluded. Operative reports identified tracheal A-frame deformity or suprastomal collapse. Results: A total of 175 children met inclusion with 18% ( Conclusions: Tracheal A-frame deformity is estimated to occur in 36% of children within 3 years after tracheostomy decannulation. Suprastomal collapse, which approaches 74% at 5 years after tracheostomy, is more common when tracheostomy is placed at a younger age. Surgeons caring for tracheostomy-dependent children should recognize acquired airway obstruction and appropriately monitor these outcomes. Level of evidence: 3.
Language	English
Publishing date	2023-12-14
Publishing country	United States
Document type	Journal Article
ISSN	2378-8038
ISSN	2378-8038
DOI	10.1002/lio2.1202
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Article ; Online: Injection Laryngoplasty for Children with Dysphagia after Cardiac Surgery.

Sheen, Derek / Houser, Thomas K / Olsson, Sofia E / Dabbous, Helene / Kou, Yann-Fuu / Johnson, Romaine F / Chorney, Stephen R

OTO open

2024 Volume 8, Issue 2, Page(s) e142

Abstract: Objective: To determine whether injection laryngoplasty (IL) resolves thin liquid aspiration among children with unilateral vocal cord paralysis (UVCP) after cardiac surgery.: Study design: Retrospective case-control.: Setting: Tertiary children's ...

Abstract	Objective: To determine whether injection laryngoplasty (IL) resolves thin liquid aspiration among children with unilateral vocal cord paralysis (UVCP) after cardiac surgery. Study design: Retrospective case-control. Setting: Tertiary children's hospital. Methods: Consecutive children (<5 years) between 2012 and 2022 with UVCP after cardiac surgery were included. Resolution of thin liquid aspiration after IL versus observation was determined for children obtaining videofluoroscopic swallow studies (VFSS). Results: A total of 32 children with left UVCP after cardiac surgery met inclusion. Initial surgeries were N = 9 (28%) patent ductus arteriosus ligations, N = 7 (22%) aortic arch surgeries, N = 9 (28%) surgeries for hypoplastic left heart syndrome, and N = 7 (22%) other cardiac surgeries. The mean age at initial surgery was 1.8 months (SD: 3.7). All children had a VFSS obtained after surgery that confirmed aspiration. There were 17 children that obtained an IL at 33.6 months (SD: 20.9) after cardiac surgery and 15 children observed without IL procedure. No surgical complications after IL were noted. The rate of aspiration resolution based on postoperative VFSS was N = 14 (82%) for the IL group and N = 9 (60%) for the control group Conclusion: IL can help treat aspiration in children with UVCP after cardiac surgery but the benefit beyond observation remains unclear. Future studies should continue to explore the utility for IL in managing dysphagia in this pediatric population.
Language	English
Publishing date	2024-04-30
Publishing country	United States
Document type	Journal Article
ISSN	2473-974X
ISSN (online)	2473-974X
DOI	10.1002/oto2.142
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