Outcomes After Tracheostomy in Patients Undergoing Congenital Heart Surgery

Early tracheostomy improves outcomes in the adult population, but there is little evidence of benefit in the pediatric population. We investigated hospital and late survival of tracheostomy placement in patients who also underwent congenital cardiac surgery.

A single-center review of 65 consecutive patients who underwent tracheostomy placement and cardiac surgery in a pediatric hospital between 2011 and 2022 was performed. Multivariable logistic regression analysis was performed to assess predictors of mortality, and a Kaplan-Meier estimate was performed to evaluate mortality.

Final analysis included 62 patients. Median birth weight and age at tracheostomy admission was 2.7 (interquartile range [IQR], 2-3) kg and 175 (IQR, 107-266) days, respectively. Patients failed extubation a median of 3 (IQR, 1-4) times. Duration of ventilation before tracheostomy was 85 (IQR, 49-106) days. Thirty-nine patients (63%) were discharged from the hospital. Thirty-eight patients (61%) died overall, of which 21 (55%) died in hospital. Median survival was 328 (IQR, 94-1711) days. Independent predictors of mortality were longer length of stay (odds ratio [OR], 4.66; 95% CI, 1.6-13.8; P < .01), tracheomalacia (OR, 0.31; 95% CI, 0.1-0.93; P = .04), sepsis (OR 3.4; 95% CI, 1.18-10; P = .02), pneumonia before or after tracheostomy (OR, 3.3; 95% CI, 1.1-10.2; P = .04), and acute kidney injury requiring dialysis (OR, 8; 95% CI, 1.96-54.5; P = .01).

With 61% mortality after tracheostomy in patients undergoing cardiac surgery in a pediatric hospital, one can wonder whether this practice improves survival in these patients. Families should be warned that, in the sickest patients, tracheostomy may only offer increased survival for a limited time.