Inflammatory Markers Stratify Surgical Outcomes in Pediatric Airway Reconstruction

Objectives Red blood cell distribution width (RDW) predicts surgical success in adult patients undergoing open airway reconstruction for laryngotracheal stenosis, but similar biomarkers in pediatrics remain unidentified. This study identifies predictors of outcomes in pediatric patients undergoing triple endoscopy or surgical airway reconstruction. Methods A retrospective cohort study of 191 pediatric patients who underwent triple endoscopy or surgical airway reconstruction at an aerodigestive center between 4/18/2013 and 4/17/2023 was completed. Ninety‐eight patients with lab values within 2 months of the procedure were included. Main outcome measures were prosthesis‐free breathing at last follow‐up, hospitalization length, and follow‐up duration. Results Lower RDW values were associated with prosthesis‐free breathing at last follow‐up ( p = 0.042) and shorter hospitalizations ( p < 0.001). Higher monocyte‐to‐lymphocyte ratio (MLR) and systemic inflammation response indexes (SIRI) correlated with increased length of hospitalization ( p = 0.003 and p = 0.01). Neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and tracheomalacia were associated with longer follow‐up periods ( p = 0.04). Patients with tracheomalacia and OSA prior to intervention were more likely to require tracheostomy at last follow‐up ( p = 0.005 and p = 0.041). Conclusions RDW may predict long‐term surgical success and outcomes in pediatric patients with complex airway, pulmonary, and upper digestive tract disorders. Serologic markers including SIRI, MLR, NLR, and PLR may also predict outcomes. Patient demographics and surgical type did not correlate with long‐term outcomes, but patients with tracheomalacia and OSA were more likely to require tracheostomy at later time points. Level of Evidence 3.