The Value of Preoperative Rigid Tracheobronchoscopy for the Diagnosis of Tracheomalacia in Oesophageal Atresia Patients
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Anne-Fleur R.L. van Hala, Irene P. Aanena, René M.H. Wijnena, Bas Pullensb, John Vlota
Background: Oesophageal atresia (OA) is often accompanied by tracheomalacia (TM). The aim of this study was to evaluate its presence in OA patients during routine rigid tracheobronchoscopy (TBS) before primary correction and compare this to postoperative TBS and clinical signs of TM.
Methods: This retrospective cohort study included patients born with OA between June 2013 and December 2022 who had received a TBS before OA correction and had been followed for at least twelve months. Definite TM was postoperatively diagnosed through TBS, and probable TM was defined as having symptoms of TM.
Results: We analysed data from 79 patients, of whom 87% with OA type C. Preoperatively, TM was observed in 33 patients (42% of all patients), seven of whom had severe TM. Definite TM was observed in 21 patients (27%), of whom 15 had severe TM. Forty-one patients (52% of all patients) had developed symptoms of TM within twelve months, including harsh barking cough (n = 15), stridor and/or wheezing (n = 20), recurrent respiratory insufficiency (n = 11), or needing airway surgery (n = 7). The sensitivity of preoperative TBS for the presence of postoperative (definite and probable combined) TM is 50.0%, 95% CI [35.2–64.8], and the specificity 67.6%, 95% CI [51.7–81.1]. Clinical characteristics did not differ between the patients with or without postoperative TM.
Conclusions: More than half of the studied patients with OA experienced symptoms of TM. While preoperative TBS is routinely performed prior to surgical OA correction, its predictive value for the presence of postoperative TM remains limited.
Transcript
How often does tracheumalacia occur before and after surgery to correct a softagel atrasia and does rigid tracheobroncoscopy help diagnose it? I'm Lizzie Lee from Cincinnati Children's Hospital and this is an article you should know about. This retrospective cohort study in the Netherlands included 79 patients who had a rigid tracheobroncoscopy, a abbreviated TBS, done before and after a softagel atrasia surgery. They wanted to know whether TBS is useful for diagnosing tracheomalacia and whether tracheomalacia worsens after the surgical repair. Results showed that the pre-op TBS for the presence of post-op tracheomalacia had a sensitivity of 50% and a specificity of 67%. This shows that pre-op TBS, though routine, has limited predictive value for post-op tracheomalacia. Let us know what to think in the comments below and stay tuned for more articles that you should know about.