(A914) Comparative Outcomes of Single-Stage and Double-Stage Laryngotracheal Reconstruction in Pediatric Subglottic Stenosis: A Systematic Review

Introduction: Laryngotracheal reconstructions in children can be performed as single-stage (ssLTR) or double-stage (dsLTR) procedures, depending on whether a tracheostomy is left in place post-surgery. This study compared decannulation rates between ssLTR and dsLTR in children with subglottic stenosis.

Methods: A systematic review was conducted to identify studies reporting ssLTR and/or dsLTR outcomes, primarily decannulation rates, in children under 18. Searches performed on PubMed, Embase, and Web of Science identified eligible studies in 10/2024. Abstracts and full texts were independently screened and reviewed by two reviewers (HS, PS) using Covidence. Data from 45 studies were extracted, stratified by Cotton-Meyer stenosis grade, and analyzed. A meta-analysis was subsequently performed using Python in Google Colab.

Results: Among 28 ssLTR studies, the pooled decannulation rate was 90.54% [95% Confidence Interval (CI): 88.70–92.40%; Standard Error (SE): 0.93%]. Heterogeneity metrics were Q = 113.81, I² = 76.28%, and Tau² = 3×10⁻⁵. According to Cotton-Meyer grade, decannulation rates were 100% for grade I (n=2), 90.63% (SD: 17.01) for grade II (n=9), 83.37% (SD: 22.84) for grade III (n=10), and 100% for grade IV (n=2).

For 26 dsLTR studies, the pooled decannulation rate was 78.19% (95% CI: 75.60–80.80%; SE: 1.34%). Heterogeneity metrics were Q = 338.23, I² = 92.61%, and Tau² = 5.53×10⁻⁵. Stratified by grade, rates were 57.69% (SD: 59.83) for grade I (n=2), 82.62% (SD: 31.79) for grade II (n=8), 74.50% (SD: 28.85) for grade III (n=9), and 66.11% (SD: 37.74) for grade IV (n=7).

Conclusions: Children undergoing ssLTR had higher decannulation rates and less heterogeneity than those undergoing dsLTR. For both approaches, rates declined with increasing stenosis severity, except for grade IV in ssLTR and grade I in dsLTR. These findings highlight ssLTR as a more consistent and effective procedure, with outcomes strongly influenced by stenosis severity.