Benefit of feeding assessment before pediatric airway reconstruction

Objectives/Hypothesis: To determine the utility of preoperative feeding ass essments in children undergoing airway reconstruction, identifying paramete rs that correlate with functional deficits in swallowing and postoperative feeding difficulties. Study Design: Prospective, sequential enrollment. Met hods: Two hundred fifty-five patients with structural abnormalities of the upper aerodigestive tract underwent endoscopic swallow studies. Classificat ion of preoperative feeding abilities, specific feeding disorders, and abno rmal endoscopic feeding parameters were used to predict the postoperative c ourse of patients undergoing airway reconstruction. The relationships betwe en diagnoses and functional feeding categories and postoperative outcomes a nd functional feeding categories were appraised by chi(2) analysis. Results : The median age of the study population was 2.5 years. Fifty-three percent of the patients were tracheotomy dependent. Only 13% of the patients had d iagnoses limited to the airway, with 45% of patients having three or more d iagnoses. Worse preoperative feeding abilities were associated with the pre sence of a tracheotomy, age 2 years or less, and multiple underlying diagno ses. Neurological diagnoses were associated with worse feeding abilities. P reoperative feeding assessments directly altered the course of management o f 15% of operative patients, by recommending a delay in the surgical correc tion, the placement of a gastrostomy tube preoperatively, or a modification in the surgical reconstruction planned for the patient. Postoperative airw ay protection predictions were 80% accurate. Twelve percent of the predicti ons involved patients who developed unforeseen complications that required additional treatments or prolonged the hospital stay secondary to difficult ies with airway protection. There was no correlation between the preoperati ve feeding abilities of the patients and their postoperative course after a irway reconstruction. Conclusion: Transient dysphagia is common after laryn gotracheal reconstruction. Preoperative feeding abilities do not correlate with the postoperative airway protection abilities of a patient. Feeding as sessments before pediatric airway reconstruction provide a means of identif ying patients with poor airway protection mechanisms that may compromise th e patient after reconstruction. Findings on swallowing evaluations that pre dict poor airway protective mechanisms are 1) pooling of secretions in the hypopharynx, 2) poor oral motor skills, allowing premature spillage of mate rial into the hypopharynx where it penetrates the larynx, and 3) residue th at persists in the hypopharynx after multiple swallows. The integration of information generated from the preoperative swallowing assessment promotes the selection of operative procedures that are optimal for that patient and highlights specific therapy issues that may need to be addressed in the po stoperative management of the patient that may not have been obvious withou t the study.