Original article
Congenital heart surgery
Tracheostomy After Operations for Congenital Heart Disease: An Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database

Presented at the Poster Session of the Fifty-second Annual Meeting of the Society of Thoracic Surgeons, Phoenix, AZ, Jan 23–27, 2016.
https://doi.org/10.1016/j.athoracsur.2016.01.046Get rights and content

Background

Information concerning tracheostomy after operations for congenital heart disease has come primarily from single-center reports. We aimed to describe the epidemiology and outcomes associated with postoperative tracheostomy in a multi-institutional registry.

Methods

The Society of Thoracic Surgeons Congenital Heart Database (2000 to 2014) was queried for all index operations with the adverse event “postoperative tracheostomy” or “respiratory failure, requiring tracheostomy.” Patients with preoperative tracheostomy or weighing less than 2.5 kg undergoing isolated closure of patent ductus arteriosus were excluded. Trends in tracheostomy incidence over time from January 2000 to June 2014 were analyzed with a Cochran-Armitage test. The patient characteristics associated with operative mortality were analyzed for January 2010 to June 2014, including deaths occurring up to 6 months after transfer of patients to long-term care facilities.

Results

From 2000 to 2014, the incidence of tracheostomy after operations for congenital heart disease increased from 0.11% in 2000 to a high of 0.76% in 2012 (p < 0.0001). From 2010 to 2014, 648 patients underwent tracheostomy. The median age at operation was 2.5 months (25th, 75th percentile: 0.4, 7). Prematurity (n = 165, 26%), genetic abnormalities (n = 298, 46%), and preoperative mechanical ventilation (n = 275, 43%) were common. Postoperative adverse events were also common, including cardiac arrest (n = 131, 20%), extracorporeal support (n = 87, 13%), phrenic or laryngeal nerve injury (n = 114, 18%), and neurologic deficit (n = 51, 8%). The operative mortality was 25% (n = 153).

Conclusions

Tracheostomy as an adverse event of operations for congenital heart disease remains rare but has been increasingly used over the past 15 years. This trend and the considerable mortality risk among patients requiring postoperative tracheostomy support the need for further research in this complex population.

Section snippets

Data Source

As of June 2014, the STS-CHSD contained deidentified data on more than 320,000 surgical procedures conducted since 2000 at 119 centers in North America. It is estimated that the database currently represents more than 95% of all centers in the United States where congenital heart operations are performed and more than 98% of all congenital and pediatric cardiac operations [7]. Preoperative, operative, and outcomes data are collected on all patients undergoing pediatric and congenital heart

Results

From January 2000 to June 2014, 211,408 index cardiovascular operations without preoperative tracheostomy were performed at the 119 centers participating in the STS-CHSD. The incidence of tracheostomy over time is illustrated in Figure 1. The rate of tracheostomy increased from 3 of 2,625 patients (0.11%; 95% CI, 0 to 0.24) in 2000 to a peak of 173 of 22,798 patients in 2012 (0.76%; 95% CI, 0.65 to 0.88) followed by 150 of 23,390 patients in 2013 (0.64%; 95% CI, 0.54 to 0.74). The overall

Comment

This study represents the largest cohort to date of patients who received tracheostomy after operations for congenital heart disease. Foremost, the incidence of tracheostomy after cardiac operations has steadily increased over the past decade. An earlier multicenter report from the Kids’ Inpatient Database similarly reported a significant increase from 1997 to 2006 in the number of patients with congenital heart disease who underwent tracheostomy as a proportion of all children undergoing

References (17)

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