National Experience With Tracheostomy in Neonates Undergoing Congenital Heart Surgery: A Multicenter Analysis

Area of Science:

• Pediatric Surgery
• Neonatal Care
• Cardiology

Background:

• Congenital heart surgery (CHS) in neonates is complex.
• Tracheostomy is sometimes required for respiratory support.
• Understanding trends and outcomes of tracheostomy in CHS is crucial.

Purpose of the Study:

• To describe trends in tracheostomy utilization among infants undergoing CHS.
• To analyze clinical and financial outcomes associated with tracheostomy in this population.

Main Methods:

• Retrospective cohort study using the Pediatric Health Information System database.
• Identified neonates (≤ 28 days) undergoing CHS with cardiopulmonary bypass (CPB) from 2004-2022.
• Compared outcomes between patients with and without tracheostomy.

Main Results:

• 3% of 13,415 CHS patients underwent tracheostomy.
• Tracheostomy patients had higher rates of prematurity, low birth weight, chromosomal, airway, and pulmonary abnormalities.
• Tracheostomy was linked to increased mortality (23.8% vs 8.6%), longer hospital stays (183 vs 26 days), and higher costs ($1.2M vs $0.2M).

Conclusions:

• Tracheostomy rates in neonates undergoing CHS have increased.
• Risk factors for tracheostomy include congenital airway/pulmonary issues and chromosomal disorders.
• Tracheostomy is associated with significantly worse clinical and financial outcomes.