Risk Factors and In-Hospital Outcomes following Tracheostomy in Infants

Abstract

Objective To describe the epidemiology, risk factors, and in-hospital outcomes of tracheostomy in infants in the neonatal intensive care unit (NICU). Study design We analyzed an electronic medical record from 348 NICUs from 1997–2012, and evaluated the associations between infant demographics, diagnoses, and pre-tracheostomy cardio-pulmonary support with in-hospital mortality. We also determined the trends in use of infant tracheostomy over time. Results We identified 885/887,910 (0.1%) infants who received a tracheostomy at a median postnatal and postmenstrual age of 72 days (25th, 75th percentile 27, 119) and 42 weeks (39, 46) respectively. The most common diagnoses associated with tracheostomy were bronchopulmonary dysplasia [396/885 (45%)], other upper airway anomalies [202/885 (23%)], and laryngeal anomalies [115/885 (13%)]. In-hospital mortality after tracheostomy was 125/885 (14%). On adjusted analysis, gestational age (GA) near term, small for gestational age (SGA) status, pulmonary diagnoses, number of days of FiO2>0.4, and inotropic support before tracheostomy were associated with increased in-hospital mortality. The proportion of infants requiring tracheostomy increased from 0.01% in 1997 to 0.1% in 2005 (P<0.001), but has remained stable since. Conclusions Tracheostomy is uncommonly performed in hospitalized infants, but the associated mortality is high. Risk factors for increased in-hospital mortality after tracheostomy include GA near term, SGA, and pulmonary diagnoses.

Considering a Weight Criterion for Neonatal Tracheostomy: An Analysis of the ACSNSQIP‐P

“…Overall 30‐day mortality for all patients was 4.24%, which is similar to previously published short‐term outcomes but less than previously published longer term outcomes, which were 8.9% to 29% . This difference is likely secondary to the morbid and chronic nature of the underlying etiology requiring the tracheostomy.…”

A decade of pediatric tracheostomies: Indications, outcomes, and long‐term prognosis

“…A second large database study showed an in‐hospital mortality of 6.6% . A recent study of 885 neonatal ICU babies with tracheostomies demonstrated an in‐hospital mortality of 14%, but did not track outcomes after hospital discharge . In comparison, our in‐hospital mortality involved 8 patients (1.9%).…”

Discussing Benefits and Risks of Tracheostomy: What Physicians Actually Say*

“…PICU placed tracheostomies frequently result in decannulation, but tracheostomy placement is not without risk. Mortality is variable based on the indications for tracheostomy, with tracheostomy placement commonly offered to our most critically ill, complex diseased children (4,5). Families want to understand the benefits and risks of this critical decision to guide them in their ultimate choice, and presentation of this information should occur prior to consent.…”