Inflammatory Markers Stratify Surgical Outcomes in Pediatric Airway Reconstruction

CLINICAL QUESTION

Do serological inflammatory markers and clinical risk factors help predict outcomes in pediatric aerodigestive patients undergoing airway reconstruction?

BOTTOM LINE

Lower red blood cell distribution width–coefficient of variation (RDW-CV) was associated with prosthesis-free breathing and shorter hospitalizations, suggesting RDW may help risk-stratify pediatric aerodigestive patients considered for airway intervention. Other inflammatory ratios like neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammation response index (SIRI) also correlated with utilization, and comorbid tracheomalacia and obstructive sleep apnea (OSA) were linked to a higher likelihood of ongoing airway prosthesis dependence.

BACKGROUND: Children with complex aerodigestive disease have variable outcomes after endoscopic evaluation and reconstructive airway surgery, and objective, easily obtainable prognostic markers are limited. CBC-derived indices (RDW and leukocyte/platelet ratios) are nonspecific inflammatory markers that may provide pragmatic perioperative risk information.

STUDY DESIGN: Retrospective cohort study using univariate testing and multivariate modeling to evaluate associations between serologic inflammatory markers/comorbidities and clinical outcomes.

SETTING: Single tertiary aerodigestive center (Vanderbilt Complex Aerodigestive Evaluation Team/Monroe Carell Jr. Children’s Hospital at Vanderbilt University Medical Center).

SYNOPSIS: Authors screened 191 pediatric patients undergoing triple endoscopy and/or surgical airway reconstruction (April 2013–April 2023) and included 98 patients who had relevant lab values within two months leading up to their procedure. The cohort’s median age was 22 months (IQR 5–81), and 65% were male. Iatrogenic causes were strongly linked to airway stenosis (67/98), followed by congenital (30/98) and traumatic etiologies (2/98). Overall, 82% had prosthesis-free breathing at the last follow-up.

On univariate analysis, lower RDW values were significantly associated with prosthesis-free breathing (p = 0.042) and shorter hospitalizations (p < 0.001). Higher MLR and SIRI were associated with longer hospital stays (p = 0.003 and p = 0.01, respectively). In multivariable analysis, RDW remained independently associated with the primary outcome (OR 0.54 per 1-unit RDW increase; 95% CI 0.30–0.86; p = 0.017), indicating that higher RDW decreased the odds of prosthesis-free breathing. Tracheomalacia (OR 0.19; p = 0.028) and OSA (OR 0.13; p = 0.024) were also independently associated with ongoing prosthesis dependence. Notably, patient demographics and surgical subtype were not predictive of long-term success.

CITATION: Dorjsuren N, et al. Inflammatory markers stratify surgical outcomes in pediatric airway reconstruction. Laryngoscope [published online ahead of print November 27, 2025]. doi:10.1002/lary.70241.

COMMENT: This study looks at RDW values to predict surgical success in pediatric patients undergoing open airway reconstruction for laryngotracheal stenosis. Ultimately, this article found that lower RDW values were associated with successful outcomes defined by prosthesis-free breathing and shorter hospitalizations after surgery. Patients with tracheomalacia and OSA before intervention were more likely to require tracheostomy at the last follow-up. This is an important study showing serologic markers may predict outcomes in this patient population.—Ryan Belcher, MD, MPH