Perioperative Outcomes After Tracheostomy Placement Among Complex Pediatric Patients

Abstract

Objectives/Hypothesis: To compare perioperative outcomes after pediatric tracheostomy placement based on patient complexity.Study Design: Retrospective case series.Methods: All patients that underwent tracheostomy placement at a tertiary children's hospital between 2015 and 2019 were followed. Children with a history of major cardiac surgery, sepsis, or total parental nutrition (TPN) were grouped as complex. Admission length, tracheostomy-related complications, in-hospital mortality, and 30-day readmissions were recorded among complex and non-complex patients.Results: A total of 238 children were included. Mean age at tracheostomy was 39.9 months (SD: 61.3), 51% were male and 51% were complex. Complex patients were younger at admission (29.9 vs. 46.8 months, P = .03), more likely to have respiratory failure (81% vs. 53%, P < .001) and more often required mechanical ventilation at discharge (86% vs. 67%, P < .001). An additional 33 days after placement was required for complex children (95% CI: 14-51, P = .001) and this group had more deaths (8% vs. 1%, P = .02); however, both groups had similar complication and readmission rates (P > .05). Total charges were higher among complex patients ($700,267 vs. $338,937, P < .001). Parametric survival analysis identified mechanical ventilation and patient complexity interacting to predict post-tracheostomy admission length.Conclusions: Hospital discharge after pediatric tracheostomy was associated with patient complexity and further influenced by mechanical ventilation. Recognition that cardiac surgery, sepsis, or TPN can predict poorer perioperative outcomes can provide quality improvement strategies for these vulnerable children.

The Impact of Socioeconomic Disadvantage on Pediatric Tracheostomy Outcomes

“…This type of regression model accounts for the unobservable variation; for example, among different services managing patients in the hospital. 36 For example, children in the CVICU would have different clinical experiences than children in the NICU. These differences in experiences and management likely affect the length of stay even among similarly ill patients and therefore should be accounted for in the model.…”

Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative

“…Patients were characterized as complex if they were diagnosed with sepsis, underwent major cardiac surgery, or needed total parental nutrition (TPN). 19 The following index hospitalization data were recorded: discharge primary service (neonatal intensive care, pediatric intensive care, cardiac intensive care, pulmonary/respiratory medicine), age at tracheostomy, weight at tracheostomy, time to first education class, rate of formal pretracheostomy consultation, speech-language pathology consultation rate, rate of speaking valve trials, audiometric assessments, accidental decannulations, tracheostomy-related complication (based on ICD-10 classifications J95.0-J95.09), total length of admission, need for mechanical ventilation at discharge, disposition (home, short-care nursing facility, in-hospital death, transfer to outside hospital), 30-day readmission rate, readmission cause (tracheostomy related-yes or no), and time to first follow-up appointment in days. The current status of each patient is reported as of December 31, 2020: alive with tracheostomy, deceased, decannulated, or lost to follow-up.…”

“…The median total cost was $515,000 and remained statistically similar over time (P = . 19). The time to first follow-up appointment decreased significantly from 115 days in 2015 to 39 days in 2019 (mean difference, 276 days; 95% CI, 2117 to 235; P \ .001).…”

Paediatric Deep Neck Infection—The Risk of Needing Intensive Care

“…However, the majority of cases can be successfully managed with endotracheal intubation. The decision to secure the airway by tracheal intubation should not be delayed because of the possibility of difficult airway management if the condition worsens (swelling, oedema) and the unacceptable risks and complications related to acute tracheostomies in children [ 83 , 84 , 85 ].…”