A Longitudinal Analysis of Outcomes in Tracheostomy Placement Among Preterm Infants

Wood, William; Wang, Cynthia S.; Mitchell, Ron B.; Shah, Gopi; Johnson, Romaine F.

doi:10.1002/lary.28864

Cited by 20 publications

(45 citation statements)

References 28 publications

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“…Rather, a 5-year decannulation rate of 49% and a 5-year mortality rate of 23% was unimpacted by race and aligns with previous studies. [6][7][8][9] Decannulation and mortality rates are, therefore, likely due to the underlying reasons for the tracheostomy remain the most important predictor of long-term outcomes. Once a tracheostomy is placed, the care and clinical metrics are comparable regardless of the child's race.…”

Section: Discussionmentioning

confidence: 99%

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Racial Influences on Pediatric Tracheostomy Outcomes

et al. 2021

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Objectives/Hypothesis To determine the impact of race on outcomes after pediatric tracheostomy. Study Design Retrospective case series. Methods A case series of tracheostomies at an urban, tertiary care children's hospital between 2014 and 2019 was conducted. Children were grouped by race to compare neurocognition, mortality, and decannulation rate. Results A total of 445 children with a median age at tracheostomy of 0.46 (interquartile range [IQR]: 0.97) years were studied. The cohort was 32% Hispanic, 31% White, 30% Black, 2.9% Asian, and 4.3% other race. Black compared to White children had a lower median birth weight (2,022 vs. 2,449 g, P = .005), were more often extremely premature (≤28 weeks gestation: 62% vs. 57%, P = .007), and more frequently had bronchopulmonary dysplasia (BPD) (35% vs. 17%, P = .002). Hispanic compared to Black children had higher median birth weight (2,529 g, P < .001), less extreme prematurity (44%, P < .001), and less BPD (21%, P = .04). The proportion of Black children was higher (30% vs. 19%, P < .001), while the proportion of Hispanic children with a tracheostomy was lower (32% vs. 42%, P = .003) compared to the racial distribution of all pediatric admissions. Racial differences were not seen for rates of severe neurocognitive disability (P = .51), decannulation (P = .17), or death (P = .92) after controlling for age, sex, prematurity, and ventilator dependence. Conclusion Black children disproportionately underwent tracheostomy and had a higher comorbidity burden than White or Hispanic children. Hispanic children had proportionally fewer tracheostomies. Neurocognitive ability, decannulation, and mortality were similar for all races implying that health disparities by race may not change long‐term outcomes after pediatric tracheostomy. Laryngoscope, 132:1118–1124, 2022

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Section: Discussionmentioning

confidence: 99%

“…Children under the age of 21 years at the time of tracheostomy were included and those with a follow-up time of 10 years or longer were excluded as most decannulations or deaths occur within this time frame. 7,8 Records are reviewed monthly to ensure accuracy.…”

Section: This Case Series With Chart Review Was Approved With Exempti...mentioning

confidence: 99%

Racial Influences on Pediatric Tracheostomy Outcomes

et al. 2021

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“…The program has previously published outcomes related to decannulation, mortality, and quality of life after tracheostomy placement. [26][27][28] Therefore, it is well-suited to examine socioeconomic effects on risk factors, hospital courses, and readmissions after tracheostomy placement.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Socioeconomic Disadvantage on Pediatric Tracheostomy Outcomes

et al. 2021

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Objectives: To determine if socioeconomic disadvantage impacts perioperative outcomes after tracheostomy. Methods: We performed a retrospective case series of children who underwent tracheostomy. Children were divided into less and more disadvantaged groups based on their community's Area Deprivation Index (ADI), a validated socioeconomic vulnerability measure. Primary outcomes were the length of stay, total cost, in-hospital mortality, and 30-day all-cause readmission after tracheostomy placement. Length of stay was further analyzed using parametric survival analysis.Results: A total of 239 patients met inclusion criteria, with 153 (64%) residing in more disadvantaged communities. Children from more disadvantaged communities were less likely to be White (42% vs. 26%, P = .009) and more likely to have Medicaid coverage (90% vs. 62%, P < .001). The two groups had similar medical complexity and comorbidities. The main outcome measures showed differences in median total length of stay (113 vs. 79 days, P = .04) and median total cost ($461 000 vs. $279 000, P = .01). Children with tracheostomies who were from more disadvantaged communities also had increased risk of prolonged hospitalizations (HR = 0.63, 95% CI = 0.48-0.83, P = .001). Readmissions, mortality rates, and quality of life scores were similar between groups.Conclusions: Community disadvantage was associated with differences in hospitalization length and costs after pediatric tracheostomy placement. Further research should continue to describe how health disparities impact children's safe and efficient care with tracheostomies.

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“…12,[15][16][17][18] Additionally, associated morbidities resulting from both the severity of lung disease as well as complications from prolonged exposure to an artificial airway include highly variable but significant rates of neurodevelopmental impairment and structural upper airway disease. [18][19][20][21][22][23][24] Roughly half of the infants born extremely premature develop moderate or severe BPD. 3,4,9 The incidence is rising, indicating that an increasing number of infants will require prolonged ventilatory support, potentially via tracheostomy.…”

Section: Introductionmentioning

confidence: 99%

“…However, even with tracheostomy placement, there remains a ~15%–20% mortality secondary to acute tracheostomy tube occlusion, unrecognized decannulation, equipment failures, and progression of lung disease 12,15–18 . Additionally, associated morbidities resulting from both the severity of lung disease as well as complications from prolonged exposure to an artificial airway include highly variable but significant rates of neurodevelopmental impairment and structural upper airway disease 18–24 …”

Section: Introductionmentioning

confidence: 99%

Morbidity and respiratory outcomes in infants requiring tracheostomy for severe bronchopulmonary dysplasia

House

Nathan

Bhuiyan

et al. 2021

Pediatric Pulmonology

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Objective: The decision for tracheostomy for bronchopulmonary dysplasia (BPD) is highly variable and often dictated by local practice. We aimed to characterize morbidity, mortality, and respiratory outcomes in preterm infants undergoing tracheostomy for severe BPD.Study Design: We retrospectively reviewed a single-center 4-year cohort of all infants born <33 weeks gestational age (GA) that required tracheostomy due to severe BPD. Indications for tracheostomy apart from BPD were excluded. Demographic information, comorbidities, respiratory management, age at tracheostomy, post-discharge respiratory outcomes, and survival were examined up to at least 5 years of age.Results: At a mean corrected GA of 43.3 weeks, 49 preterm infants with severe BPD required tracheostomy. Forty-six infants (94%) had long-term follow-up.Compared to survivors, the 12 (26.1%) infants that died were significantly more likely to be small for gestational age (SGA) or require treatment for pulmonary hypertension. GA, birth weight, sex, antenatal corticosteroid exposure, need for patent ductus arteriosus ligation, and magnitude of respiratory support at tracheostomy placement were not associated with mortality. At the latest follow-up, 97% were liberated from mechanical ventilation and 79% decannulated. Morbidities of the upper airway were common, and 13/27 (47%) decannulated infants had required airway reconstruction. Conclusion:Preterm infants undergoing tracheostomy experienced significant mortality, particularly those who were SGA or had pulmonary hypertension. However, by 5 years of age, most infants liberalized from mechanical ventilation and decannulated. Magnitude of respiratory support at time of tracheostomy was not associated with mortality and should not deter intervention. Nearly half of patients required airway reconstruction before decannulation.

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A Longitudinal Analysis of Outcomes in Tracheostomy Placement Among Preterm Infants

Cited by 20 publications

References 28 publications

Racial Influences on Pediatric Tracheostomy Outcomes

Racial Influences on Pediatric Tracheostomy Outcomes

The Impact of Socioeconomic Disadvantage on Pediatric Tracheostomy Outcomes

Morbidity and respiratory outcomes in infants requiring tracheostomy for severe bronchopulmonary dysplasia

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