Impact of Posterior Tracheopexy on Morbidity and Survival in Children With Severe Tracheomalacia
Bibliographic record
Abstract
Abstract INTRODUCTION Severe tracheomalacia is a condition characterized by an abnormality in the anatomy of the trachea, leading to its collapse, with a wide range of clinical manifestations from cough to dependence on mechanical ventilation. It has a low prevalence and a high association with other congenital malformations. Posterior tracheopexy, which involves fixing the posterior wall of the trachea to the spine, is a definitive treatment option for this condition in the pediatric population. OBJECTIVES This study evaluated the impact of posterior tracheopexy on morbidity and survival in patients with severe tracheomalacia operated on by a pediatric airway surgery group in Colombia. MATERIALS AND METHODS This retrospective analytical study evaluated the experience of the airway group across five centers in Colombia (two cities) from May 2018 to April 2024. All surgeries were performed by the same surgeon with interdisciplinary support from the different institutions. Kaplan-Meier method was used for survival analysis, and Wilcoxon and McNemar tests were used to analyze pre- and postoperative respiratory variables. RESULTS A total of 22 children were included, with 68.1% (n=15) having a median age at diagnosis of 9months. Prior to surgery, 40.9% (n=9) had a tracheostomy, and 63.6% (n=14) were using supplemental oxygen. The median age at surgery was 13 months, and the most common additional procedure was descending aortopexy (40.9%, n=9). The median stay in the PICU was 10 days (IQR21 days), and the median total hospitalization was 26 days (IQR 35 days). The most common pre-surgical symptom was a “barking” cough, present in 100% (n=22) of patients, which resolved after the procedure. Recurrent respiratory infections (90.9% vs. 0% post-surgery, p<0.0001) and noisy breathing (77.2% vs. 4.5% post-surgery, p<0.0001) significantly decreased. Six-year survival was85.6%, and six-month mortality was secondary to comorbidities. Three children died after the eighth postoperative week due to causes not attributable to the surgical procedure. CONCLUSIONS Posterior tracheopexy is a surgical alternative for managing severe tracheomalacia due to posterior wall collapse. In our cohort, unique to Colombia and Latin America, it showed a statistically significant improvement in respiratory morbidity and a high six-year survival rate. The results highlight the impact of multidisciplinary management on the quality of life for patients and their families. Table 1. Comparison of symptoms reported before and after undergoing posterior tracheopexy %(n)Before Surgery After Surgery p-valueCough100.0 (22)0(0)-Inspiratory Stridor59.1 (13)4.5 (1) 0,002 Expiratory Stridor54.5 (12)0(0) 0,002 Noisy Breathing77.3 (17)4.5 (1)-Recurrent Respiratory Tract Infections90.9 (20)0 (0)-Gastrointestinal Symptoms63.6 (14)18.2 (4) 0,004 Supplemental Oxygen Requirement63.6 (14)27.3 (6) 0,008
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".