Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P132

Pediatric

P132
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
(SMGE), with or without the addition of parotid duct ligation
reported improvement in symptoms and satisfaction with
(PDL) or parotid duct rerouting (PDR). This study aimed to
-follow-up communication. In addition, 11% presented to the
compare these surgical approaches and their outcomes. Data
emergency department for posttonsillectomy complications,
sources were PubMed, Web of Science, and Embase.
3% required hospital admission for observation, and 3%
Methods: Following Preferred Reporting Items for Systematic
required return to the operating room.
Reviews and Meta-Analyses reporting standards, we performed
Conclusions: Telehealth was successful in reducing the numa systematic review of English-language articles evaluating
ber of posttonsillectomy office visits for pediatric patients
patients with chronic sialorrhea managed with SMGE alone or
without a subsequent increase in complications. Reduction in
SMGE plus PDR or PDL. Two independent investigators
office visits can lead to cost reduction, increased availability
assessed study eligibility, rated quality with the Methodological
of pediatric otolaryngology appointments, and improvement
Index for Non-Randomized Studies instrument, and extracted
in access for patients.
data for analysis.
Results: Of 3186 studies identified, 21 met the inclusion criTiming the First Pediatric Tracheostomy Tube
teria, with a total of 708 patients. A total of 103 patients underChange: A Randomized Controlled Trial
went SMGE alone (15%), 299 underwent SMGE and PDL
Stephen R. Chorney, MD (Presenter); Rosemary C.
(42%), and 306 underwent SMGE plus PDR. Preoperative
Patel, MSN; Allison E. Boyd, MSN; Joanne Stow, MSN; Mary M.
rates of recurrent lower respiratory tract infections were 72%
Schmitt, MSN, CPNP-AC; Deborah Lipman, MSN, CPNP-AC;
(95% CI, 46%-88%). Overall, most patients had significant
Terri Giordano, MSN; Steven E. Sobol, MD, MSc, FRCSC
improvement: 82% (95% CI, 73%-89%) of SMGE patients,
Objectives: The first pediatric tracheostomy tube change
79% (95% CI, 73%-85%) of SMGE and PDL patients, and
often occurs within 7 days after placement; however, the opti85% (95% CI, 75%-92%) of SMGE and PDR patients had
mal timing is not known.
very good to excellent control of symptoms after surgery.
Methods: A randomized controlled trial enrolled children
Importantly, there was no significant difference in outcomes
younger than 24 months to early (day 4) or late (day 7) first
when PDL or PDR was performed in addition to SMGE. Some
tracheostomy tube changes. All tracheostomies were placed at
complications reported were sialocele, parotitis, dental caries,
a high-volume tertiary children's hospital between October
and dry mouth.
2018 and December 2019. The primary objective was to deterConclusions: Our systematic review identified consistent
mine the safety of an early change. Secondary objectives compositive outcomes with SMGE for patients with chronic sialpared rates of peristomal wounds, sedation requirements, and
orrhea but no additional benefit when PDR or PDL was perexpedited intensive care discharges.
formed as a concurrent procedure.
Results: Fifteen children were enrolled with 10 randomly
assigned to an early change. The mean age was 7.1 months
Telehealth as an Effective Method for
(SD, 3.7), and 86.7% required tracheostomy for respiratory
Pediatric Post-tonsillectomy Follow-up
failure. All tracheostomy changes were performed safely
Alyssa J. Smith, MD; Shelagh A. Cofer, MD;
without any complications. There were no accidental decanLaura J. Orvidas, MD
nulations. Significant peristomal wounds developed in 10% of
Objectives: Many otolaryngologists continue to see their
early changes and 80% of late changes (P = .02). Early changes
postoperative tonsillectomy patients as an in-office visit. The
required fewer midazolam boluses (13.6 vs 26.8; P = .03) and
information shared during these visits can likely be gathered
less midazolam (12.6 vs 25.8 mg; P = .03) during the first
via telehealth methods, such as telephone calls and portal
7 days. Duration of dexmedetomidine sedation was reduced
messaging. This study aimed to determine if pediatric patients
by 28.9% in the early change group (P = .16). After the first
can be safely and effectively managed postoperatively with
change, 40% of the early group were discharged from intennurse-led communication rather than an office visit.
sive care within 2 weeks and 90% discharged by 5 weeks
Methods: A retrospective chart review was conducted on
compared with 25% of patients in the late group (P = .04).
patients younger than 18 years who underwent tonsillectomy
Conclusions: The first tracheostomy tube change in children
at our institution from 2012 to 2019. Beginning in September
can safely occur on day 4 resulting in fewer peristomal
2013, the patients were managed postoperatively with a telewounds, less sedation, and earlier intensive care discharge.
health communication on postoperative days (PODs) 3 to 5
and again at 4 to 6 weeks. Prior to implementation, each
Tracheostomy Complications in Extremely
patient received telephone follow-up on PODs 3 to 5 and folPremature Neonates
low-up appointment with their surgeon 4 to 6 weeks after surKevin Shaigany, MD (Presenter); Amal Isaiah, MD, PhD;
gery. Satisfaction with follow-up, number of office visits, and
Diego A. Preciado, MD, PhD; Karen B. Zur, MD; Jenna W.
postoperative complications were recorded.
Briddell, MD; Carolyn M. Jenks, MD; Kevin D.
Results: The percentage of postoperative visits decreased
Pereira, MD, MS(ORL)
from 98% preimplementation to 23% immediately postObjectives: The timing of tracheostomy in extremely premaimplementation. In 2019 alone, only 21 patients (11%)
ture infants is affected by pulmonary disease and influences
attended follow-up appointments, and 98% of overall parents

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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