Surgical interventions on the trachea in a multidisciplinary pediatric hospital

BACKGROUND: Tracheal surgery in children is an interdisciplinary challenge that requires a high level of professional collaboration among thoracic surgeons, anesthesiologists–intensivists, endoscopists, otorhinolaryngologists, rehabilitation specialists, and palliative care professionals, in the setting of appropriate diagnostic and technical resources. This issue is particularly acute in leading regional medical institutions of the Russian Federation, including regional, territorial, republican, and district pediatric hospitals.

AIM: To substantiate the need for and to assess the effectiveness of thoracic surgery services within the structure of multidisciplinary pediatric hospitals in the regions of Russia.

METHODS: Medical and statistical data from the Speransky Children’s City Clinical Hospital No. 9 of the Moscow Department of Health were used as a typological model, as this institution is comparable in bed capacity, number, and profile of structural units to most multidisciplinary pediatric hospitals in the Russian Federation. Between 2020 and 2025, a total of 201 tracheal surgeries were performed in 186 children ranging in age from infancy to 17 years. Infants predominated (86 children), accounting for 46.2% of clinical cases. The protocol of specialized examination methods included imaging, endoscopic, and laboratory techniques aimed at assessing respiratory failure, bacteriological studies of biological fluids, and verification of the level and extent of tracheal lesions.

RESULTS: Analysis of patients according to the type and frequency of surgical interventions showed that tracheostomy predominated (153 children, 82.2%); tracheal stenosis dilatation was performed in 27 children (14.5%), and tracheal reconstruction in 6 cases (3.2%). The incidence and profile of surgical complications following tracheal surgery, including in the long-term period, were comparable to those reported by leading specialized centers.

CONCLUSION: The functioning of thoracic surgery units (specialized beds) in multidisciplinary pediatric hospitals of the Russian regions represents a rational solution to a wide range of organizational and clinical challenges, including resource-intensive issues of medical evacuation to other institutions. Under current conditions of a significant shortage of physicians, the acquisition of competencies in thoracic surgery within the existing qualification of pediatric surgery falls within the remit of the Ministry of Health of the Russian Federation, as it necessitates improvement of the regulatory framework. In the medium term, concentration of specialized patients in interregional centers for specialized (surgical) pediatric care appears to be a rational approach.