Predictors of Clinical Outcomes and Hospital Resource Use of Children After Tracheotomy

Abstract

OBJECTIVES The objectives are to describe health outcomes and hospital resource use of children after tracheotomy and identify patient characteristics that correlate with outcomes and hospital resource use. PATIENTS AND METHODS A retrospective analysis of 917 children aged 0 to 18 years undergoing tracheotomy from 36 children’s hospitals in 2002 with follow-up through 2007. Children were identified from ICD-9-CM tracheotomy procedure codes. Comorbid conditions (neurologic impairment [NI], chronic lung disease, upper airway anomaly, prematurity, and trauma) were identified with ICD-9-CM diagnostic codes. Patient characteristics were compared with in-hospital mortality, decannulation, and hospital resource use by using generalized estimating equations. RESULTS Forty-eight percent of children were ≤6 months old at tracheotomy placement. Chronic lung disease (56%), NI (48%), and upper airway anomaly (47%) were the most common underlying comorbid conditions. During hospitalization for tracheotomy placement, children with an upper airway anomaly experienced less mortality (3.3% vs 11.7%; P < .001) than children without an upper airway anomaly. Five years after tracheotomy, children with NI experienced greater mortality (8.8% vs 3.5%; P≤.01), less decannulation (5.0% vs 11.0%; P≤.01), and more total number of days in the hospital (mean [SE]: 39.5 [4.0] vs 25.6 [2.6] days; P≤.01) than children without NI. These findings remained significant (P < .01) in multivariate analysis after controlling for other significant cofactors. CONCLUSIONS Children with upper airway anomaly experienced less mortality, and children with NI experienced higher mortality rates and greater hospital resource use after tracheotomy. Additional research is needed to explore additional factors that may influence health outcomes in children with tracheotomy.

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

“…In comparison, in a retrospective analysis of 917 children with any diagnoses undergoing tracheostomy from 36 children's hospitals, Berry and colleagues reported an in-hospital mortality of only 7.7%. [13] Additionally, in-hospital mortality of our cohort was also higher than reported in the majority of the available single center studies. [1,[3][4][5] This finding possibly reflects the inclusion of deaths that occur in patients discharged to chronic care or rehabilitation facilities.…”

“…Indeed, in the study by Berry and colleagues, 19% of all patients who had tracheostomies had been discharged to a postacute care facility after at least one admission and 9.6% had only been discharged to such a facility. [13] The in-hospital mortality rate of 25% in this report is therefore likely more indicative of the proportion of deaths that are suffered by these patients prior to being discharged home.…”

Outcomes of Children With Severe Bronchopulmonary Dysplasia Who Were Ventilator Dependent at Home

“…The rehospitalization rate was significantly higher before decannulation; the most frequent reason for rehospitalization was respiratory related, as previously described. 35,36 Although no other studies have addressed the rehospitalization rates for children with tracheostomy, before and after decannulation, several have found that children who are ventilator dependent at home have a higher risk of rehospitalization than other children. 11,12,[36][37][38][39] The decrease in readmission rate after decannulation may be secondary to removal of the tracheostomy, improvement in BPD, or both.…”

Prior Cardiac Surgery Is Independently Associated With Decreased Survival Following Infant Tracheostomy

“…[1][2][3] These reviews have reported a mortality rate of 34 -47%, significantly higher than the mortality rates reported in non-cardiac surgical populations. [4][5][6] Two large multi-institutional studies performed by Berry and colleagues 7,8 demonstrated increased risk of in-hospital mortality following tracheostomy in children with congenital heart disease, the majority of whom had undergone cardiac surgical repair or palliation. To our knowledge, no study to date has determined whether tracheostomy following pediatric cardiac surgery continues to be associated with poorer outcomes following hospital discharge relative to patients who require tracheostomy in association with other disease processes.…”