Considering a Weight Criterion for Neonatal Tracheostomy: An Analysis of the <scp>ACS</scp><scp>NSQIP</scp>‐<scp>P</scp>

Rawal, Rounak B.; Farquhar, Douglas R.; Kilpatrick, Lauren A.; Drake, Amelia F.; Zdanski, Carlton J.

doi:10.1002/lary.27272

Cited by 6 publications

(3 citation statements)

References 23 publications

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“…Many of these techniques have been employed at this institution with encouraging outcomes 25 . Although lower weight at tracheostomy has not been related to differences in 30‐day mortality, 26 the length of follow‐up in this series approaches 2 years, which may lend to this finding. Further investigation on the role of weight at tracheostomy will be required.…”

Section: Discussionmentioning

confidence: 68%

Mortality Among Children with a Tracheostomy

et al. 2022

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Objectives To characterize the cause of death among children with a tracheostomy. Study Design Prospective cohort. Methods All pediatric patients (<18 years) who had a tracheostomy placed at a tertiary care institution between 2015 and 2020 were included. The location and cause of death were recorded along with patient demographics and age. Results A total of 271 tracheostomies were placed with 46 mortalities reviewed for a mortality rate of 16.8%. Mean age at placement was 1.7 years (SD: 3.4) and mean age at death was 2.9 years (SD: 3.5). Most tracheostomies were placed for respiratory failure (N = 33, 72%). The mean time to death after tracheostomy was 1.2 years (SD: 1.2) and 28% (N = 13) occurred during the same admission as placement. Mean time to death after hospital discharge was 1.3 years (SD: 1.3). Etiology of death was respiratory failure (33%, N = 15), cardiopulmonary arrest (15%, N = 7), unknown (43%, N = 20), or secondary to a tracheostomy‐related complication for 9% (N = 4). Location of death was in intensive care units for 41% (N = 19) and 30% died at home (N = 14). Comfort care measures were taken for 37% (N = 17). Severe neurological disability (HR: 4.06, p = 0.003, 95% CI: 1.59–10.34) and congenital heart disease (HR: 2.36, p = 0.009, 95% CI: 1.24–4.48) correlated with time to death on Cox proportional hazard modeling. Conclusions Nearly one‐third of children with a tracheostomy who expire will do so during the same admission as tracheostomy placement. Although progression of underlying disease will lead to most deaths, 9% will be a result of a tracheostomy‐related complication, which represents a meaningful target for quality improvement initiatives. Level of Evidence 3 Laryngoscope, 133:403–409, 2023

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Section: Discussionmentioning

confidence: 68%

Mortality Among Children with a Tracheostomy

et al. 2022

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“…Surgery‐specific information (eg, patient weight) is not captured by these registries. As such, the relationship between low weight and adverse outcomes, which was inconclusive in a prior investigation on pediatric tracheostomy outcomes, 49 remains uncertain. Lastly, the NRD estimations of readmissions are from a separate database and thus used mainly for perspective purposes, as these data are not captured in the KID.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Tracheostomy‐Related Complications: A Cross‐sectional Analysis

Newton

Johnson

Wynings

et al. 2021

Otolaryngol.--head neck surg.

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Objective To determine the rate of tracheostomy-related complications in pediatric patients from nationally representative databases. Study Design Cross-sectional analysis. Setting 2016 Kids’ Inpatient Database and 2016 Nationwide Readmission Database. Methods All pediatric tracheostomy procedures were included. Complication type, admission outcomes, and readmission rates were recorded with a logistic regression analysis to determine patient characteristics associated with complications. Results An estimated 5309 tracheostomies were performed among pediatric patients in 2016, 8% (n = 432) of whom developed tracheostomy-related complications. This group was younger (4.7 vs 8.7 years, P < .001) and required longer hospital admissions (68.7 vs 33.2 days, P < .001) than children without tracheostomy-related complications. Mean costs ($459,324 vs $397,937, P < .001) and mean total charges ($1,573,964 vs $1,099,347, P < .001) were increased if a tracheostomy-related complication occurred. These events occurred more often in those with bronchopulmonary dysplasia (24% vs 12%, P < .001), heart disease (24% vs 12%, P = .001), gastroesophageal reflux disease (31% vs 19%, P < .001), short gestational age (24% vs 14%, P < .001), and subglottic stenosis (9.9% vs 5.4%, P = .001). The estimated 30-day readmission rate was 24% (SE, 1.7%) but did not increase after tracheostomy complications (27% vs 15%, P = .04). Tracheostomy-related complications were predicted by gastroesophageal reflux disease (odds ratio [OR], 1.50; 95% CI, 1.14-1.97; P = .004), younger age (OR, 1.12; 95% CI, 1.04-1.22; P = .002), and lengthier hospitalization (OR, 1.00; 95% CI, 1.00-1.01; P < .001) on multiple logistic regression analysis. Conclusion Tracheostomy-related complications occur in approximately 8% of pediatric patients and are higher in younger children or those with longer admission lengths. These data have implications for benchmarking standards of posttracheostomy complications across institutions.

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“…*data not available; DP: diaphragmatic palsy; n: number Because pediatric tracheostomies are required due to children's increased medical complexity, they are associated with high fatality rates. The mortality rate varies from less than 1% in patients having surgery for obstructive sleep apnea (OSA) to 26% in those with hypoplastic left heart syndrome[17][18][19][20][21][22][23][24][25][26]. The chosen studies are summarized in Table4.…”

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confidence: 99%

Hemi-Diaphragm Plication and/or Tracheostomy Are Valuable Adjunctive Procedures After Repair of Congenital Heart Defects in Children: A Systematic Review

Bhende,

Sharma,

Krishnakumar

et al. 2023

Cureus

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Diaphragmatic paralysis (DP), whether unilateral or bilateral, often leads to extended recovery and more severe complications, particularly in neonates and infants undergoing congenital heart surgery. This condition's impact is most pronounced after single-ventricle palliative procedures. Tracheostomy prevalence is rising in pediatric patients with congenital heart disease (CHD) despite its association with high resource utilization and in-hospital mortality. This study examines the reported incidence of diaphragmatic paralysis and timing of tracheostomy in pediatric patients undergoing surgery for congenital heart disease in the literature and a retrospective analysis of cases in our institution between 2018 and 2023, offering insights for prospective management. An electronic search of PubMed databases retrieved 10 studies on pediatric tracheostomy and 11 studies on DP. Our retrospective analysis included 15 patients, of whom 10 underwent tracheostomy, four underwent diaphragmatic plication, and one underwent both.Postoperative tracheostomy had an 11.8% mortality rate in our systematic review, rising to 40% in our observational study. Diaphragm repair and early diagnosis can reduce morbidity, prevent complications, and improve patients' quality of life.

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Considering a Weight Criterion for Neonatal Tracheostomy: An Analysis of the ACSNSQIP‐P

Abstract: 4. Laryngoscope, 2018.

Cited by 6 publications

References 23 publications

Mortality Among Children with a Tracheostomy

Mortality Among Children with a Tracheostomy

Pediatric Tracheostomy‐Related Complications: A Cross‐sectional Analysis

Hemi-Diaphragm Plication and/or Tracheostomy Are Valuable Adjunctive Procedures After Repair of Congenital Heart Defects in Children: A Systematic Review

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