Hospital outcomes for pediatric heart transplant recipients undergoing tracheostomy: A multi-institutional analysis

Area of Science:

• Pediatric Cardiology
• Thoracic Surgery
• Healthcare Outcomes Research

Background:

• Tracheostomy is linked to worse outcomes in children with congenital heart disease (CHD).
• The impact of tracheostomy on pediatric heart transplant (HTx) recipients is not well understood.

Purpose of the Study:

• To determine the prevalence of tracheostomy in pediatric HTx recipients.
• To compare hospital outcomes, including mortality and resource utilization, between pediatric HTx patients with pre-transplant tracheostomy (Pre-TT), post-transplant tracheostomy (Post-TT), and no tracheostomy.

Main Methods:

• Multi-institutional retrospective cohort study.
• Utilized the Pediatric Health Information System database.
• Compared hospital mortality, mediastinitis, length of stay (LOS), and costs.

Main Results:

• Pre-TT occurred in 1.1% and Post-TT in 1.6% of pediatric HTx hospitalizations.
• Pre-TT patients were younger and had higher rates of CHD, non-cardiac birth defects, or airway anomalies.
• Neither Pre-TT nor Post-TT was associated with mediastinitis.
• Post-TT and younger age at HTx (<1 year) were independently associated with increased in-hospital mortality.
• Pre-TT during the HTx hospitalization and Post-TT were associated with increased resource utilization (LOS and costs).

Conclusions:

• Tracheostomy is not associated with mediastinitis in pediatric heart transplant recipients.
• Post-transplant tracheostomy is associated with increased in-hospital mortality and resource utilization.
• Pre-transplant tracheostomy is not independently associated with increased mortality but is linked to higher resource utilization.