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Epidemiology of pediatric tracheotomy: A population-based study using National Health Insurance Research Database in
Kun-Tai Kang1, Yu-Sheng Lin2, Che-Yi Lin3
1Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
Insights
Pediatric tracheostomy is common in Taiwan, with infants facing higher risks of prolonged hospital stays and mortality. This population-based study highlights age-related differences in tracheostomy outcomes.
Area of Science:
- Pediatric Surgery
- Public Health
- Epidemiology
Background:
- Tracheostomy in children carries significant risks, yet population-based data is limited.
- Understanding pediatric tracheostomy epidemiology is crucial for improving patient care and outcomes.
Purpose of the Study:
- To analyze population-based data on pediatric tracheostomy in Taiwan.
- To investigate differences in characteristics and outcomes across various pediatric age groups.
Main Methods:
- Utilized Taiwan's National Health Insurance Research Database (1997-2016).
- Identified all children (<18 years) undergoing tracheostomy.
- Compared demographic, clinical, and mortality data between age groups.
Main Results:
- 2300 children underwent tracheostomy; 43.3% were adolescents (12-18 years).
- Pulmonary and neurological disorders were primary indications.
- Infants (<1 year) experienced longer ICU/hospital stays and higher 5-year mortality compared to adolescents.
- Younger age correlated with increased risk of prolonged hospitalization and long-term mortality.
Conclusions:
- This study provides comprehensive epidemiological insights into pediatric tracheostomy across different age groups in Taiwan.
- Findings underscore the heightened risks associated with tracheostomy in younger children, particularly infants.
Objective:
Tracheostomy in children is a surgical procedure with considerable morbidity and mortality. However, there is still a lack of population-based survey in pediatric tracheostomy. This study analyses population-based data in pediatric tracheostomy among different ages in Taiwan.
Methods:
This study used National Health Insurance Research Database in Taiwan. All children (aged <18 years) who underwent tracheostomy during 1997-2016 were identified. We retrieved data regarding baseline characteristics, perioperative care, and mortality associated with pediatric tracheostomy, and compared differences in variables between different age groups.
Results:
We observed that 2300 children received tracheostomy (mean age, 8.7 years; 64% boys). Regarding the age group distribution of the patients, 585 (25.4%) were infants (<1 year), 227 (9.9%) were toddlers (1-3 years), 175 (7.6%) were preschool-aged children (3-6 years), 317 (13.8%) were school-aged children (6-12 years), and 996 (43.3%) were adolescents (12-18 years). Surgical indications included pulmonary disorders (64.9%), neurological disorders (38.4%), trauma (32.3%), head injury (25.2%), and congenital anomalies (21.5%). Of these patients, 94.9% required intensive care unit (ICU) care, with the mean length of ICU stay being 63.8 days. The mean length of hospital stay was 74.5 days. The overall mortality at the last follow-up was 43.96% (1011/2300), and the tracheostomy related mortality at the last follow-up was 1.43% (33/2300). Compared with adolescents, infants more commonly underwent tracheostomy in the northern area (66.7% vs 37.2%, P < .001), more commonly received tracheostomy indicated by congenital anomalies (53.7 vs 4.6%, P < .001), had longer ICU stays, had longer hospital stays (100.7 vs 57.5 days, P < .001), and had a higher 5-year mortality rate (42.4 vs 29.6%, P < .001). Multivariable logistic and Cox regression models revealed that young age was associated with an increased risk of prolonged hospital stay and long-term mortality, respectively.
Conclusions:
This study elaborates the epidemiology of pediatric tracheostomy in different age groups.
