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Characterizing mortality in pediatric tracheostomy patients
Jamie L Funamura1, Sonia Yuen1, Kosuke Kawai1,2
1Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Insights
Pediatric tracheostomy patients face high mortality risks, particularly those with cardiopulmonary conditions. Most deaths occur post-hospitalization, with bronchopulmonary dysplasia and congenital heart disease being key predictors.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Surgical outcomes research
Background:
- Tracheostomy is a vital procedure for pediatric patients with airway compromise or respiratory failure.
- Longitudinal data on mortality risk following pediatric tracheostomy is limited.
- Understanding risk factors is crucial for improving patient management and outcomes.
Purpose of the Study:
- To evaluate the long-term risk of death in children undergoing tracheostomy.
- To identify demographic and clinical factors associated with mortality after tracheostomy.
- To determine the timing of death relative to the tracheostomy procedure.
Main Methods:
- Retrospective cohort study of 513 pediatric patients (≤18 years) who underwent tracheostomy.
- Data collected from hospital records between 1984 and 2015.
- Statistical analysis included Cox proportional hazards models to assess mortality risk.
Main Results:
- The median age at tracheostomy was 0.8 years.
- The highest mortality rate (27.8%) was observed in adolescents (13-18 years).
- Cardiopulmonary indications (adjusted hazard ratio: 3.53) and conditions like bronchopulmonary dysplasia (aHR: 2.63) and congenital heart disease (aHR: 2.61) significantly increased mortality risk.
Conclusions:
- Pediatric tracheostomy is associated with substantial long-term mortality.
- Cardiopulmonary disease as an indication for tracheostomy is a major risk factor.
- Bronchopulmonary dysplasia and congenital heart disease are independent predictors of mortality in this population.
Objectives/Hypothesis:
To assess the longitudinal risk of death following tracheostomy in the pediatric age group.
Study Design:
Retrospective cohort study.
Methods:
Hospital records of 513 children (≤18 years) at a tertiary care children's hospital who underwent tracheostomy between 1984 and 2015 were reviewed. The primary outcome measure was time from tracheostomy to death. Secondary patient demographic and clinical characteristics were assessed, with likelihood of death using χ2 tests and the Cox proportional hazards model.
Results:
Median age at time of tracheostomy was 0.8 years (interquartile range, 0.3-5.2 years).The highest mortality rate (27.8%) was observed in patients in the 13- to 18-year-old age category; their mortality rate was significantly higher when compared to the lowest mortality risk group patients (age 1-4 years, P = .031). Timing of death was evenly distributed: <90 days (37.6%), 90 days to 1 year (27.1%), and >1 year after tracheostomy (35.3%). Patients who underwent tracheostomy for cardiopulmonary disease had an increased risk of mortality compared with airway obstruction (adjusted hazard ratio: 3.53, 95% confidence interval: 1.72-7.24, P < .001) and other indications. Adjusted hazard ratios for bronchopulmonary dysplasia (BPD) and congenital heart disease (CHD) were 2.63 and a 2.61, respectively (P < .001).
Conclusions:
Pediatric patients with tracheostomy have a high mortality rate, with an increased risk of death associated with a cardiopulmonary indication for undergoing tracheostomy. The majority of deaths occur after the index hospitalization during which the tracheostomy was performed. BPD and CHD are independent predictors of mortality in pediatric tracheostomy patients.
Level Of Evidence:
4 Laryngoscope, 127:1701-1706, 2017.
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