Immediate versus delayed surgery in congenital choanal atresia: A systematic review.

Choanal Atresia / mortality Humans Respiratory Function Tests Time Factors Treatment Failure
Choanal atresia Congenital anomalies Outcomes research Pediatric rhinology

Journal

International journal of pediatric otorhinolaryngology
ISSN: 1872-8464
Titre abrégé: Int J Pediatr Otorhinolaryngol
Pays: Ireland
ID NLM: 8003603

Informations de publication

Date de publication:
Apr 2019
Historique:
received: 18 08 2018
revised: 28 11 2018
accepted: 02 01 2019
pubmed: 22 1 2019
medline: 1 5 2019
entrez: 22 1 2019
Statut: ppublish

Résumé

To evaluate immediate versus delayed surgical intervention on treatment outcomes in the management of congenital choanal atresia. This study adhered to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines in reporting a systematic review of the literature. OVID Medline, EMBASE and Pubmed databases were searched using relevant key terms. Inclusion and exclusion criteria were designed to capture studies examining immediate versus delayed primary surgery for congenital choanal atresia. Timing of surgery was classified as immediate or delayed based on median age of intervention stratified by type of obstruction. Primary outcomes were primary treatment failure, respiratory function and mortality rates. A total of 2765 abstracts were identified and screened by 2 independent reviewers. Of the 688 articles reviewed in full text, 23 articles met the study criteria and were subjected to quality assessment. The full study assessment and quality control measures yielded 23 studies (representing 362 patients) for pooled patient-level analysis in the systematic review. Primary treatment failures occurred in 24.8% of patients that underwent immediate surgery and 42.6% of patients that underwent delayed surgery for bilateral choanal atresia (p = 0.01). There were no differences in mortality rates (5.6% vs 4.2%; p = 1.00) or qualitative measures of respiratory function. There were no difference in treatment outcomes for patients with unilateral choanal atresia (p > 0.05). Through an analysis of pooled individual patient data, this systematic review of the literature demonstrated that there was significantly higher rates of treatment failure in patients that underwent delayed surgery for bilateral choanal atresia. Clinical trials and large prospective cohort studies investigating outcomes following immediate and delayed surgical intervention will provide further insight into treatment strategies.

Identifiants

DOI: 10.1016/j.ijporl.2019.01.001 PMID: 30665176
pubmed: 30665176
pii: S0165-5876(19)30002-3
doi: 10.1016/j.ijporl.2019.01.001
pii:
doi:

Types de publication

Comparative Study Journal Article Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

47-53

Informations de copyright

Copyright © 2019 Elsevier B.V. All rights reserved.

Auteurs

Scott Murray (S)

University of Alberta, Department of Otolaryngology, Head and Neck Surgery, Edmonton, AB, Canada.

Lindy Luo (L)

University of Ottawa, Department of Undergraduate Medical Education, Ottawa, ON, Canada.

Alexandra Quimby (A)

University of Ottawa, Department of Otolaryngology - Head and Neck Surgery, Ottawa, ON, Canada; The Ottawa Hospital, Department of Otolaryngology - Head and Neck Surgery, Ottawa, ON, Canada.

Nick Barrowman (N)

Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.

Jean-Philippe Vaccani (JP)

University of Ottawa, Department of Otolaryngology - Head and Neck Surgery, Ottawa, ON, Canada; The Ottawa Hospital, Department of Otolaryngology - Head and Neck Surgery, Ottawa, ON, Canada; Children's Hospital of Eastern Ontario, Division of Otolaryngology - Head and Neck Surgery, Ottawa, ON, Canada.

Lisa Caulley (L)

University of Ottawa, Department of Otolaryngology - Head and Neck Surgery, Ottawa, ON, Canada; The Ottawa Hospital, Department of Otolaryngology - Head and Neck Surgery, Ottawa, ON, Canada. Electronic address: Lic955@mail.harvard.edu.

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Classifications MeSH

questionsmedicales.fr › Malformations et maladies congénitales, héréditaires et néonatales › Malformations › Malformations de l'appareil respiratoire › Atrésie des choanes › Immediate versus delayed surgery in congenital...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Immediate versus delayed surgery in congenital...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic respiratoire › Tests de la fonction respiratoire › Immediate versus delayed surgery in congenital...
questionsmedicales.fr › Phénomènes physiques › Temps › Facteurs temps › Immediate versus delayed surgery in congenital...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Échec thérapeutique › Immediate versus delayed surgery in congenital...