Comparing Long‐Term Outcomes in Tracheostomy Placed in the First Year of Life

Salley, Jordan R.; Kou, Yann Fuu; Shah, Gopi; Johnson, Romaine F.

doi:10.1002/lary.29440

Cited by 5 publications

(8 citation statements)

References 41 publications

(95 reference statements)

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“…The design of the CHAMP tracheostomy program allows for close monitoring of children for several years after placement. Although retrospective outcomes have been the focus of prior publications from our center, 17,18,20 this ambidirectional cohort describes mortality and (A) (B) decannulation at 1, 5, and 10 years. The primary findings were that cumulative mortality estimates were 12%, 26%, and 42% at 1, 5, and 10 years after tracheostomy while cumulative decannulation estimates at 1, 5, and 10 years were 10%, 45%, and 54%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Outcomes of Tracheostomy‐Dependent Children

Liu

Teplitzky

Kou

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo estimate the 1‐, 5‐, and 10‐year survival and decannulation rates of children with a tracheostomy.Study DesignAmbidirectional cohort.SettingTertiary children's hospital.MethodsAll patients (<18 years) that had a tracheostomy placed between 2009 and 2020 were included and followed until 21 years of age, decannulation, or death. The Kaplan‐Meier method estimated cumulative probabilities of death and decannulation.ResultsA total of 551 children underwent tracheostomy at a median age of 7.2 months (interquartile range [IQR]: 3.8‐49.2). Children were followed for a median of 2.1 years (IQR: 0.7‐4.2, range 0‐11.5). The cumulative probability of mortality at 1 year was 11.9% (95% confidence interval [CI]: 9.4‐15.1), at 5 years was 26.1% (95% CI: 21.6‐31.3), and at 10 years was 41.6% (95% CI: 32.7‐51.8). Ventilator dependence at index discharge (hazard ratio [HR]: 2.04, 95% CI: 1.10‐3.81, p = .03), severe neurologic disability (HR: 2.79, 95% CI: 1.61‐4.84, p < .001), and cardiac disease (HR: 1.69, 95% CI: 1.08‐2.65, p = .02) were associated with time to death. The cumulative probability of decannulation was 10.4% (95% CI: 8.0‐13.5), 44.9% (95% CI: 39.4‐50.9), and 54.1% (95% CI: 47.4‐61.1) at 1 year, 5 years, and 10 years, respectively. Ventilator dependence (HR: 0.43, 95% CI: 0.31‐0.60, p < .001), severe neurologic disability (HR: 0.20, 95% CI: 0.14‐0.30, p < .001), and tracheostomy indicated for respiratory failure (HR: 0.68, 95% CI: 0.48‐0.96, p = .03) correlated with longer decannulation times.ConclusionAfter tracheostomy, estimated mortality approaches 42% by 10 years and decannulation approaches 54%. Children with ventilator support at discharge and severe neurological disability had poorer long‐term survival and longer times to decannulation.

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Section: Discussionmentioning

confidence: 99%

Long‐Term Outcomes of Tracheostomy‐Dependent Children

Liu

Teplitzky

Kou

et al. 2023

Otolaryngol.--head neck surg.

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“…4 This results in prolonged tracheostomy dependence for children with anticipated decannulation often taking several years, if achievable. 5 While a tracheostomy is in place, children may necessitate frequent hospital readmissions. [6][7][8][9][10] They also require health care services such as elective surgeries, speech and language therapy, physical and occupational therapy, and routine follow-up visits.…”

mentioning

confidence: 99%

“…Tracheostomies are typically placed for severe illnesses that cause respiratory failure, airway obstruction, and poor pulmonary hygiene 4 . This results in prolonged tracheostomy dependence for children with anticipated decannulation often taking several years, if achievable 5 …”

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confidence: 99%

Economic Evaluation of Pediatric Tracheostomy: A Cost of Illness Analysis

Zhang,

Liu,

Narayanan

et al. 2024

OTO Open

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ObjectiveThis study aimed to determine the direct costs of pediatric tracheostomy care within a health care system.Study DesignProspective analysis.SettingAcademic children's hospital.MethodsCosts associated with caring for pediatric tracheostomy patients under 18 years were analyzed between 2015 and 2021. Direct costs were calculated using the Medicare/Medicaid charges‐to‐costs ratio for various visit types. Costs were estimated using generalized linear equations, accounting for confounders.ResultsA total of 297 children underwent tracheostomy at a median age of 0.94 years. The median follow‐up was 2.5 years, resulting in 13,966 visits (mean = 41). The total cost was $321 million. The initial admission accounted for 72% ($231 million) of costs while other inpatient admissions added 24% ($78 million). Emergency department, observation, and outpatient visits comprised 4% of costs. The length of stay (LOS) was the primary cost driver for inpatient visits. Each additional hospital day increased costs by roughly $1195, and each extra admission added about $130,223 after adjusting for confounders. Respiratory failure and infections were the primary reasons for 67% of subsequent admissions.ConclusionPediatric tracheostomy care generated over $300 million in direct costs over 5 years. Inpatient stays constituted 96% of these costs, with the LOS being a major factor. To reduce direct health expenditures for these patients, the focus should be on minimizing admissions.

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“…These occur at lower rates than late complications, such as stomal granulation, accidental decannulation, and tracheocutaneous fistula 13 . Hospitalized pediatric tracheostomy has an 8% mortality rate and long-term mortality was found to be closer to 15% in the general pediatric population 14,17 …”

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confidence: 99%

“…13 Hospitalized pediatric tracheostomy has an 8% mortality rate and long-term mortality was found to be closer to 15% in the general pediatric population. 14,17 To our knowledge, these rates have not been investigated in tracheostomized craniofacial patients, whose facial anomalies may pose specific challenges in their overall management and outcomes. The purpose of this study is to examine tracheostomy-associated morbidities and mortalities in craniofacial patients.…”

mentioning

confidence: 99%

Tracheostomy, the Not So Definitive Airway?: Tracheostomy Morbidity in Pediatric Craniofacial Patients

La-Anyane,

Whitney,

Harmon

et al. 2023

Journal of Craniofacial Surgery

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Background: Tracheostomy is the definitive treatment for airway management in severe cases of craniofacial-associated upper airway obstruction, like the Pierre-Robin sequence, but is associated with significant morbidity. The purpose of this study was to examine tracheostomy-associated morbidities and mortalities in craniofacial patients to identify opportunities to improve clinical care and patient prognosis. Methods: The study was a retrospective review of pediatric craniofacial patients who were tracheostomized between 2016 and 2022. Data regarding their demographics, craniofacial diagnoses, endoscopic airway anomalies, intubation grade of view classification, tracheostomy-related complications, and causes of mortality were analyzed. Results: Sixteen of the 17 tracheostomized pediatric patients had the Pierre-Robin sequence, with 5 of those patients having an additional syndromic craniofacial diagnosis. Additional airway anomalies were found in 82.4% of the patients. The mean length of hospital stay after tracheostomy was 4.08 months. Infection was the most common complication, observed in 94.1% of patients, followed by stomal granulation in 76.5% of patients. Two mortalities were observed: one following the compassionate removal of ventilator support and the other following the accidental dislodgment of the tracheostomy tube. Conclusions: Tracheostomy-related complications were observed in all craniofacial patients in this group. Compared with the general pediatric population, tracheostomized craniofacial patients may endure longer hospital stays and greater stomal granulation rates. Mandibular distraction osteogenesis may allow for tracheostomy avoidance in these patients, and future research should focus on comparing the long-term complication rates and outcomes between tracheostomy mandibular distraction osteogenesis in this challenging patient population.

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Comparing Long‐Term Outcomes in Tracheostomy Placed in the First Year of Life

Cited by 5 publications

References 41 publications

Long‐Term Outcomes of Tracheostomy‐Dependent Children

Long‐Term Outcomes of Tracheostomy‐Dependent Children

Economic Evaluation of Pediatric Tracheostomy: A Cost of Illness Analysis

Tracheostomy, the Not So Definitive Airway?: Tracheostomy Morbidity in Pediatric Craniofacial Patients

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