Frequency and Indications for Tracheostomy and Gastrostomy After Congenital Heart Surgery

Abstract

Patients undergoing congenital heart surgery may occasionally require additional surgical procedures in the form of tracheostomy and gastrostomy. These procedures are often performed in an attempt to diminish hospital morbidity and length of stay. We reviewed the Web-based medical records of all patients undergoing congenital heart surgery at Miami Children's Hospital from February 2002 through August 2007. Patients who were deemed preterm and had undergone closure of a patent ductus arteriosis were eliminated. The records of all other patients were queried for the terms gastrostomy, g-tube, Nissan, fundal plication, tracheostomy, or tracheotomy. Patients' medical records in which these terms appeared in any portion were completely reviewed. There were 1660 congenital heart operations performed in the study period. There were 592 operations performed on patients whose age ranged from 1 month to 1 year and 441 neonatal operations. Mortality was 2%. Median postoperative stay was 8 days (range, 1-191 days), 12 days for neonates (range, 3-142 days), and 19 days for neonates undergoing RACHS-1 category 6 operations (range, 4-142 days). Tracheostomies were performed in four patients (0.2%). Gastrostomies were performed on eight patients (0.4%), representing 0.8% of patients <1 year of age, 1.4% of neonates, and 2.4% of patients undergoing RACHS-1 category 6 operations. The rate of patients undergoing either tracheostomy or gastrostomy after congenital heart surgery at our institution was quite low. Avoidance of either of these two procedures was achieved without increased morbidity or length of stay. The rate at which these procedures need to be performed may reflect the magnitude of the patients' lifetime trauma related to their underlying condition and acute and total surgical experiences.

Tracheostomy After Operations for Congenital Heart Disease: An Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database

“…Several institutions have reported their experiences with pediatric patients requiring tracheostomy following cardiac surgery. [1][2][3][4][5] The incidence of tracheostomy after pediatric cardiac surgery in these reviews ranged from 0.2-2.7%. Inhospital mortality was much more variable, ranging from 0-40% [1][2][3][4][5].…”

“…[1][2][3][4][5] In order to better understand the epidemiology of patients who undergo tracheostomy after surgery for congenital heart disease, analysis of a larger cohort of patients from multiple centers is needed. To our knowledge, no such multi-center study related specifically to patients who undergo tracheostomy after surgery for congenital heart disease has been conducted.…”

Tracheostomy in children with congenital heart disease: a national analysis of the Kids’ Inpatient Database

“…Single-institution studies (Challapudi, Natarajan & Aggarwal; LoTempio & Shapiro; Hoskote et al, 2005; Rossi et al, 2009; Cotts et al, 2011; Costello et al, 2014) have reported indications and outcomes of tracheostomy in this population, but these studies have been small (sample size range: 4–59) and lack external validity because of substantial heterogeneity in institutional practices surrounding postoperative ventilator management and decision making about tracheostomy. These studies report different patterns of how commonly tracheostomy is used in this population and the timing of its performance.…”

Tracheostomy in Infants With Congenital Heart Disease: A Nationwide Population-Based Study in Taiwan

“…The reported incidence of tracheostomy in children with CHD is low in the literature, 17,18,21 with a rate of 0.2% among pediatric subjects undergoing cardiovascular surgery 17 and 3.5% among pediatric admissions with CHD. 21 In this study, the rate was 0.4% among infants with CHD.…”

“…6,[8][9][10][11][12] However, most studies have focused on the indications for tracheostomy, the subsequent outcomes, or resource utilization. 6,[10][11][12][13][14][15][16][17][18][19][20][21][22] Data are scant regarding the epidemiological risk factors for tracheostomy in CHD, and there have been no large-scale population-based studies. Furthermore, among infants with CHD requiring a tracheostomy, previous studies have failed to investigate either the overall mortality risk or the mortality risk stratified by a follow-up period.…”