Outcomes of Tracheostomy Following Congenital Heart Surgery: A Contemporary Experience

Abstract

The timing of tracheostomy placement may be an important factor in clinical outcomes for pediatric patients with persistent dependence on mechanical ventilatory support following congenital heart surgery. A larger, multi-institution study may help further elucidate our observed clinical findings in this patient population.

Characterizing mortality in pediatric tracheostomy patients

“…Despite a low rate of tracheostomy procedures in children following congenital heart surgery (1.2%–2.7%), history of prior cardiac surgery has been identified as an independent risk factor for mortality in infants within 1 year after tracheostomy . Although children with congenital heart disease have a higher mortality rate following tracheostomy than children without, they rarely die during the index hospitalization; in‐hospital mortality is equivalent to that of children without congenital heart disease . Further investigation of these associations is warranted because there is a nationwide trend toward performing more tracheostomies in children with congenital heart disease …”

“…The current literature suggests that there may be independent risk factors for mortality following pediatric tracheostomy . Further characterization of these risks may be difficult to capture through national inpatient databases that can be limited by coding error bias and inability to follow individual patients longitudinally.…”

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

“…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.…”