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

Abstract

INTRODUCTION: Previous reports have demonstrated that prior cardiac surgery is independently associated with in-hospital mortality after infant tracheostomy. We aimed to determine whether these infants would continue to be at increased risk for death following hospital discharge. METHODS: A retrospective review was performed on subjects < 2 y of age who recovered from tracheostomy in the pediatric ICU at our institution between January 2007 and December 2011, with follow-up to December 2013. Survival to 1 y following tracheostomy was the primary outcome variable for the study. Multivariate Cox regression analysis was then performed to determine independent risk factors for death after infant tracheostomy. RESULTS: Forty-two subjects met inclusion criteria, 18 of whom had undergone prior cardiac surgery. Twenty-six subjects (62%) were alive at 1 y post-tracheostomy. Age at tracheostomy, concomitant genetic abnormalities or prematurity, and ventilator dependence at discharge were not statistically different between survivors and those who died. Subjects who died, however, were more likely to have had cardiac surgery prior to tracheostomy (11 [69%] vs 7 [27%], P ‫؍‬ .008) and had longer hospital stay (median 3.4 months [interquartile range: 2.6 -4.6] vs 2.2 months [interquartile range: 1.1-3.5], P ‫؍‬ .045). Multivariate Cox regression analysis revealed only prior cardiac surgery to be independently associated with decreased survival after tracheostomy (hazard ratio 4.7, 95% CI 1.3-16.4, P ‫؍‬ .02). CONCLUSIONS: Prior cardiac surgery is independently associated with decreased survival within 1 y following tracheostomy. Clinicians and families of infants with prior cardiac surgery in whom tracheostomy after cardiac surgery is deemed necessary should consider this risk when planning long-term care.

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

“…[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.…”

“…Several institutions have reported their experiences with pediatric patients requiring tracheostomy following cardiac surgery. [1][2][3][4][5] The incidence of tracheostomy after pediatric cardiac surgery in these reviews ranged from 0.2-2.7%. Inhospital mortality was much more variable, ranging from 0-40% [1][2][3][4][5].…”

“…[4,5] In a study by Berry and colleagues reporting data from a large multiinstitutional database, children with congenital heart disease who underwent tracheostomies had the highest in-hospital mortality when compared to children who underwent tracheostomies in association with other underlying illnesses. [6] A more recent single center study by Rosner et al reported survival at 2 years after tracheostomy to be just 28% in patients with a history of prior cardiac surgery as compared to 75% in patients with no history of cardiac surgery [5]. Tracheostomy after cardiac surgery therefore appears to be relatively infrequent but associated with high mortality.…”

“…[1][2][3][4][5] In order to better understand the epidemiology of patients who undergo tracheostomy after surgery for congenital heart disease, analysis of a larger cohort of patients from multiple centers is needed. To our knowledge, no such multi-center study related specifically to patients who undergo tracheostomy after surgery for congenital heart disease has been conducted.…”

Risk factor analysis for mortality among infants requiring tracheostomy

“…Current literature related to long‐term outcomes of children with tracheostomy placement and BPD shows mixed outcomes. While some studies report similar or even decreased rates of mortality in patients with BPD compared with other children with tracheostomy . others have found that BPD and prematurity are independent risk factors for mortality in children with tracheostomy …”