Related Experiment Video
Updated: Oct 23, 2025
Anesthesia and Intubation of Preadolescent Mouse Pups for Cardiothoracic Surgery
Published on: June 2, 2022
Risk of Pediatric Cardiac Surgery Increased in Patients Undergoing Tracheal Surgery During the Same Hospitalization
Kyle W Riggs1,2, Dennis Wells1,3, Farhan Zafar1,3
12518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Pediatric patients undergoing tracheal surgery (TS) along with cardiac surgery face significantly higher in-hospital mortality risks and increased healthcare costs. This heightened risk associated with combined cardiac and tracheal surgeries needs greater recognition.
Area of Science:
- Pediatric Surgery
- Cardiology
- Thoracic Surgery
Background:
- The impact of complex tracheal surgery (TS) on outcomes for pediatric patients undergoing cardiac surgery is understudied in large national databases.
- Investigating this impact is crucial for accurately predicting outcomes in this vulnerable patient population.
Purpose of the Study:
- To evaluate the association between concurrent tracheal surgery (TS) and cardiac surgery (CS) on patient outcomes.
- To compare hospital mortality, length of stay, cost, and readmission rates between pediatric patients who underwent both CS and TS versus CS alone.
Main Methods:
- A retrospective review of the Pediatric Health Information System database (2005-2014).
- Identification of pediatric patients (<18 years) undergoing select cardiac surgical procedures using ICD-9 codes.
- Propensity matching of patients with concurrent cardiac and tracheal surgeries (CHS+TS) to those with isolated cardiac surgery (CHS) in a 1:2 ratio.
Main Results:
- Patients undergoing CHS+TS (n=283) exhibited a significantly higher hospital mortality rate (13.8%) compared to CHS-only patients (5.8%).
- CHS+TS was associated with a substantially longer length of stay (63 vs. 12 days), higher hospitalization costs ($322,402 vs. $80,273), and increased readmission rates (64.3% vs. 41.8%).
- The groups were similar in gender, race, age, cardiac procedures, and chromosomal abnormalities prior to matching.
Conclusions:
- Concurrent tracheal surgery in pediatric patients undergoing cardiac surgery significantly increases the risk of in-hospital mortality.
- Combined cardiac and tracheal surgery leads to greater resource utilization, including longer hospital stays, higher costs, and more readmissions.
- The elevated mortality risk associated with combined procedures is currently underappreciated and requires careful consideration when managing patient expectations.
Background:
The impact of complex tracheal surgery (TS) on outcomes of children undergoing cardiac surgery has rarely been investigated in large national databases and could impact anticipated outcomes in those patients.
Methods:
The Pediatric Health Information System database was reviewed from January 1, 2005 to December 31, 2014, for pediatric (<18 years) patients undergoing select cardiac surgical procedures using International Classification of Disease-9 procedural coding. Patients were divided based upon having TS (excluding tracheostomy) during the same hospitalization. Patients with tracheal and cardiac surgeries (CHS + TS) were propensity matched in a 1 : 2 fashion to patients undergoing isolated cardiac surgeries without TS (CHS) based upon cardiac procedure(s), age at surgery, gender, and discharge year. Hospital mortality and other outcomes were compared between the 2 matched groups.
Results:
The 283 CHS + TS patients were similar to the 566 CHS patients in gender, race, age, cardiac procedures, and presence of chromosomal abnormalities, all P > .05. Hospital mortality was 13.8% (n = 39) for CHS + TS and 5.8% (n = 33) for CHS patients with an unadjusted 2.58 hazard ratio of death (95% confidence interval: 1.59-4.20; P < .001). CHS + TS was also associated with a greater length of stay (63 days vs 12 days), a higher cost per hospitalization ($322 402 vs $80 273), and more readmissions (64.3% [n = 182] vs 41.8% [n = 243]), all P < .001.
Conclusions:
Patients undergoing cardiac and TS in the same hospitalization are at greater risk of in-hospital mortality than patients undergoing similar cardiac surgeries alone and incur higher resource utilization thereafter. The increased risk of mortality is currently underappreciated, but it is important to recognize when discussing expectations with families and providers.
Related Concept Videos
01:22Trachea
Anatomical Features:
Location: About half of the trachea is situated in the neck, anterior to the esophagus, and extends from the larynx (at the level of...
01:16Tracheostomy Care I: Pre-procedural Steps
Required Equipment
The equipment necessary for tracheostomy care includes:
01:26Tracheostomy Suctioning I: Pre-Procedural Steps
Equipment Required
First, gather all necessary equipment: a sterile suction catheter, a sterile disposable container, sterile gloves, a towel or...
01:28Tracheostomy: Procedure and Tubes
Tracheostomy tubes can be made of semiflexible plastic (polyurethane or silicone), rigid plastic, or metal, and they come in...
01:23Oxygen Delivering System III: Tracheostomy and T-piece
Tracheostomy
A tracheostomy is a surgically created opening (stoma) in the anterior part of the trachea. It is used to establish a patient airway, bypass an upper airway obstruction, simplify the removal of secretions, permit long-term...
01:25Tracheostomy Care II: Procedure
Step 1: Perform hand hygiene, and put on personal protective equipment: gown, gloves, mask...