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Airway Anomalies in Pediatric Patients After Surgery for Congenital Heart Disease: Single-Center Retrospective Cohort
Jeng-Hung Wu1,2, En-Ting Wu1, Heng-Wen Chou3
1Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
Insights
Airway anomalies affect nearly one-quarter of pediatric patients with congenital heart disease (CHD) post-surgery. These anomalies are linked to increased mortality, longer ventilation, and extended intensive care unit stays.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Medical Imaging
Background:
- Airway anomalies pose significant risks to pediatric patients with congenital heart disease (CHD) undergoing surgery.
- Early identification and management are crucial for improving outcomes.
Purpose of the Study:
- To identify the prevalence of airway anomalies in pediatric patients with CHD.
- To investigate the association between airway anomalies and intermediate outcomes in this population.
Main Methods:
- Retrospective study of pediatric patients who underwent CHD surgery and airway evaluation (CT scan or bronchoscopy) between 2017-2020.
- Analysis of factors associated with airway anomalies and their impact on mortality, intubation duration, and PICU length of stay.
Main Results:
- 22.6% of 820 pediatric CHD patients had airway anomalies, including structural and dynamic issues.
- Premature birth, genetic syndromes, and preoperative ventilator use were associated with higher odds of airway anomalies.
- Airway anomalies correlated with increased hospital mortality, prolonged intubation, and longer PICU stays.
Conclusions:
- Airway anomalies are prevalent in pediatric CHD patients post-surgery, affecting nearly one in four.
- Risk factors for airway anomalies include premature birth, genetic syndromes, and preoperative ventilation.
- The presence of airway anomalies significantly worsens intermediate outcomes, including mortality and resource utilization.
Objectives:
Airway anomalies increase risk of morbidity and mortality in postoperative pediatric patients with congenital heart disease (CHD). We aimed to identify airway anomalies and the association with intermediate outcomes in patients undergoing surgery for CHD.
Design:
Single-center, hospital-based retrospective study in Taiwan, 2017-2020.
Setting:
A tertiary referral hospital in Taiwan.
Patients:
All pediatric patients who underwent surgery for CHD and were admitted to the PICU and had data about airway evaluation by cardiopulmonary CT scan or bronchoscopy.
Interventions:
None.
Measurements And Main Results:
Among 820 CHD patients identified as having undergone airway evaluation in the PICU, 185 (22.6%) were diagnosed with airway anomalies, including structural lesions in 146 of 185 (78.9%), and dynamic problems were seen in 87 of 185 (47.0%). In this population, the explanatory factors associated with greater odds (odds ratio [OR]) of airway anomaly were premature birth (OR, 1.90; p = 0.002), genetic syndromes (OR, 2.60; p < 0.001), and in those with preoperative ventilator use (OR, 4.28; p < 0.001). In comparison to those without airway anomalies, the presence of airway anomalies was associated with higher hospital mortality (11.4% vs. 2.7%; p < 0.001), prolonged intubation days (8 d [1-27 d] vs. 1 d [1-5 d]; p < 0.001), longer PICU length of stay (23 d [8-81 d] vs. 7 d [4-18 d]; p < 0.001), and greater hazard of intermediate mortality (adjusted hazard ratio, 2.60; p = 0.001).
Conclusions:
In our single-center retrospective study, 2017-2020, between one-in-five and one-in-four of our postoperative CHD patients undergoing an airway evaluation had airway anomalies. Factors associated with greater odds of airway anomaly included, those with premature birth, or genetic syndromes, and preoperative ventilator use. Overall, in patients undergoing airway evaluation, the finding of an airway anomalies was associated with longer postoperative intubation duration and greater hazard of intermediate mortality.
