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Perioperative Outcomes After Tracheostomy Placement Among Complex Pediatric Patients
Christian Davidson1, Benjamin Jacob1, Ashley Brown2
1Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.
Insights
Pediatric tracheostomy outcomes are worse for complex patients, especially those on mechanical ventilation. Identifying risk factors like cardiac surgery, sepsis, or TPN can improve care for these children.
Area of Science:
- Pediatric surgery
- Critical care medicine
- Healthcare outcomes research
Background:
- Pediatric tracheostomy is a critical intervention for airway management in children.
- Patient complexity, defined by factors like cardiac surgery, sepsis, or total parenteral nutrition (TPN), may influence perioperative outcomes.
- Understanding these complexities is vital for optimizing care pathways.
Purpose of the Study:
- To compare perioperative outcomes in children undergoing tracheostomy, stratified by patient complexity.
- To identify specific factors contributing to variations in outcomes.
Main Methods:
- A retrospective case series of 238 children who underwent tracheostomy between 2015 and 2019 at a tertiary children's hospital.
- Patients were categorized as complex (history of major cardiac surgery, sepsis, or TPN) or non-complex.
- Outcomes analyzed included admission length, tracheostomy complications, in-hospital mortality, and 30-day readmissions.
Main Results:
- Complex pediatric patients were younger, more likely to have respiratory failure, and required mechanical ventilation more often.
- Complex patients experienced longer hospital stays (33 additional days) and higher in-hospital mortality (8% vs. 1%).
- Complication and readmission rates were similar between groups, but total charges were significantly higher for complex patients.
Conclusions:
- Patient complexity, particularly when combined with mechanical ventilation, significantly impacts hospital discharge length after pediatric tracheostomy.
- Recognizing cardiac surgery, sepsis, or TPN as predictors of poorer outcomes can inform quality improvement strategies for vulnerable pediatric populations.
Objectives/Hypothesis:
To compare perioperative outcomes after pediatric tracheostomy placement based on patient complexity.
Study Design:
Retrospective case series.
Methods:
All patients that underwent tracheostomy placement at a tertiary children's hospital between 2015 and 2019 were followed. Children with a history of major cardiac surgery, sepsis, or total parental nutrition (TPN) were grouped as complex. Admission length, tracheostomy-related complications, in-hospital mortality, and 30-day readmissions were recorded among complex and non-complex patients.
Results:
A total of 238 children were included. Mean age at tracheostomy was 39.9 months (SD: 61.3), 51% were male and 51% were complex. Complex patients were younger at admission (29.9 vs. 46.8 months, P = .03), more likely to have respiratory failure (81% vs. 53%, P < .001) and more often required mechanical ventilation at discharge (86% vs. 67%, P < .001). An additional 33 days after placement was required for complex children (95% CI: 14-51, P = .001) and this group had more deaths (8% vs. 1%, P = .02); however, both groups had similar complication and readmission rates (P > .05). Total charges were higher among complex patients ($700,267 vs. $338,937, P < .001). Parametric survival analysis identified mechanical ventilation and patient complexity interacting to predict post-tracheostomy admission length.
Conclusions:
Hospital discharge after pediatric tracheostomy was associated with patient complexity and further influenced by mechanical ventilation. Recognition that cardiac surgery, sepsis, or TPN can predict poorer perioperative outcomes can provide quality improvement strategies for these vulnerable children.
Level Of Evidence:
4 Laryngoscope, 131:E2469-E2474, 2021.
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