Tracheostomy, Feeding-Tube, and In-Hospital Postoperative Mortality in Children: A Retrospective Cohort Study

Area of Science:

• Pediatric Surgery
• Neurology
• Critical Care Medicine

Background:

• Neuromuscular/neurologic diseases increase perioperative mortality risk in children.
• Tracheostomy and/or feeding tubes are used for airway obstruction, respiratory failure, and aspiration risk.
• The impact of these devices on postoperative mortality in this population was previously unevaluated.

Purpose of the Study:

• To assess differences in postoperative mortality between children with and without tracheostomy/feeding tubes.
• To analyze the association of these devices with 3- and 30-day in-hospital mortality.
• To stratify mortality risk based on device use and surgical characteristics.

Main Methods:

• Retrospective cohort study of 43,193 children (1 month-18 years) with neuromuscular/neurologic disease.
• Data collected from April 2016 to October 2018 across 44 US children's hospitals.
• Analysis of 3- and 30-day in-hospital mortality, comparing patients with tracheostomy, feeding tube, both, or neither device.

Main Results:

• Children with feeding tubes or both devices had more comorbidities (e.g., dysphagia, pulmonary disease, cerebral palsy) and prior ICU stays.
• Having a feeding tube was associated with decreased 3-day mortality overall (0.9% vs 1.3%, P = .003).
• Both devices were associated with decreased 3-day mortality in low-risk surgery and urgent/emergent hospitalizations; feeding tubes also showed benefit for 30-day mortality stratified by comorbidities.

Conclusions:

• Patients requiring tracheostomy/feeding tubes are generally sicker but feeding tubes are associated with lower short-term mortality.
• The presence of both devices correlated with reduced 3-day mortality in specific surgical contexts (low-risk, urgent/emergent).
• Findings suggest potential protective effects of feeding tubes and combined devices in certain pediatric surgical populations with neuromuscular/neurologic conditions.