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Published on: May 26, 2023
Characteristics and Outcomes of Home-Ventilated Children Undergoing Noncardiac Surgery
Jia Liu1,2, Anna Kordun3, Steven J Staffa3
1Divisions of Anesthesiology, Pain, and Perioperative Medicine.
Insights
Children with chronic respiratory failure (CRF) needing home ventilation undergo frequent surgeries. Transtracheal mechanical ventilation (trach/vent) dependence is linked to higher resource use and readmission risks, requiring further study for optimized care.
Area of Science:
- Pediatric Anesthesiology
- Pediatric Critical Care Medicine
- Pediatric Surgery
Background:
- Children with chronic respiratory failure (CRF) and home ventilator dependence represent a growing population requiring surgical interventions.
- These patients often have complex medical needs and require specialized perioperative care.
- Understanding the frequency and outcomes of surgical procedures in this population is crucial for optimizing resource allocation and patient management.
Purpose of the Study:
- To determine the frequency of children with CRF and home ventilator dependence undergoing surgery.
- To describe the periprocedural characteristics and outcomes of these patients.
- To identify factors associated with 30-day readmission in this vulnerable cohort.
Main Methods:
- Retrospective cohort study of patients with CRF and home ventilator dependence undergoing noncardiac surgery between 2013 and 2019.
- Descriptive statistics were used for patient and procedural characteristics.
- Univariable and multivariable analyses assessed factors associated with 30-day readmission.
Main Results:
- 416 patients underwent 1623 procedures; 51% used transtracheal mechanical ventilation (trach/vent).
- Trach/vent patients were younger, more complex (ASA status), and had longer ICU stays (median 5 vs. 2 days) compared to bilevel positive airway pressure (BiPAP) users.
- The overall 30-day readmission rate was 12%. Chronic lung disease and trach/vent dependence were independently associated with increased readmission odds.
Conclusions:
- Children with CRF frequently utilize surgical and anesthetic services, with trach/vent users exhibiting higher resource utilization.
- While mortality is low, frequent readmissions highlight the need for further investigation into underlying diagnoses and technology dependence.
- Optimizing resource utilization and outcomes for these complex pediatric surgical patients requires continued study.
Objectives:
To determine the frequency of children with chronic respiratory failure (CRF) and home ventilator dependence undergoing surgery at a tertiary children's hospital, and to describe periprocedural characteristics and outcomes.
Methods:
We conducted a retrospective cohort study of patients with CRF and home ventilator dependence who underwent noncardiac surgery from January 1, 2013, to December 31, 2019. Descriptive statistics were used to report patient and procedural characteristics. Univariable and multivariable analyses were used to assess for factors associated with 30-day readmission.
Results:
We identified 416 patients who underwent 1623 procedures. Fifty-one percent of patients used transtracheal mechanical ventilation (trach/vent) support at the time of surgery; this cohort was younger (median age 5.5 vs 10.8 years) and more complex according to American Society of Anesthesiologists status compared with bilevel positive airway pressure-dependent patients. Postoperatively, compared with bilevel positive airway pressure-dependent patients, trach/vent patients were more likely to be admitted to the ICU with longer ICU length of stay (median 5 vs 2 days). Overall 30-day readmission rate was 12% (n = 193). Presence of chronic lung disease (adjusted odds ratio 1.65, 95% confidence interval 1.01-1.69) and trach/vent dependence (adjusted odds ratio 1.65, 95% confidence interval 1.02-2.67) were independently associated with increased odds for readmission.
Conclusions:
Children with CRF use anesthetic and surgical services frequently and repeatedly. Those with trach/vent dependence have higher hospital and ICU resource utilization. Although overall mortality for these patients is quite low, underlying diagnoses, nuances of technology dependence, and other factors for frequent readmission require further study to optimize resource utilization and outcomes.
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