Original articleCongenital heart surgeryTracheostomy After Operations for Congenital Heart Disease: An Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database
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)
- et al.
Tracheostomy in infants and children after cardiothoracic surgery: indications, associated risk factors, and timing
J Thorac Cardiovasc Surg
(2005) - et al.
Tracheostomy after pediatric cardiac surgery: frequency, indications, and outcomes J
Thorac Cardiovasc Surg
(2011) - et al.
The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database
J Thorac Cardiovasc Surg
(2009) Risk adjustment for congenital heart surgery: the RACHS-1 method
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu
(2004)- et al.
Tracheostomy tube placement in children following cardiothoracic surgery: indications and outcomes
Am J Otolaryngol
(2002) - et al.
Frequency and indications for tracheostomy and gastrostomy after congenital heart surgery
Pediatr Cardiol
(2009) - et al.
Prior cardiac surgery is independently associated with decreased survival following infant tracheostomy
Respir Care
(2015) - et al.
Patient characteristics associated with in-hospital mortality in children following tracheotomy
Arch Dis Child
(2010)
Cited by (30)
Factors Associated With Mortality and Adverse Outcomes After Truncus Arteriosus Repair
2023, Annals of Thoracic SurgeryTracheostomy practices in children on mechanical ventilation: a systematic review and meta-analysis
2022, Jornal de PediatriaCitation Excerpt :Other authors reported rates of successful decannulation varying from 12.6% to 77.8%, after median times from 123 days to 38 months.14,16,19,22,32,37,38 In children requiring surgery for congenital heart disease and a tracheostomy, hospital discharge rates are as low as 50%, in those patients with pulmonary artery shunts, hypoplastic left heart syndrome, and coexisting genetic syndromes.46–49 In neurologically impaired children, Tsuboi et al. reported that rates of successful decannulation within one year and five years were 4% and 17% respectively, compared to 20% and 54% in children without neurological impairment.50
Outpatient healthcare use and outcomes after pediatric tracheostomy
2021, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Conversely, higher mortality was associated with CHD. This supports prior work suggesting that tracheostomy in children following cardiac surgery is associated with high mortality, particularly in children with single ventricle physiology undergoing surgical palliation [19–21]. CLD, NI, and UAO were all independently associated with increased home ventilator dependence and tracheostomy complications.
Characteristics and operative outcomes for children undergoing repair of truncus arteriosus: A contemporary multicenter analysis
2019, Journal of Thoracic and Cardiovascular SurgeryMulticenter Analysis of Early Childhood Outcomes After Repair of Truncus Arteriosus
2019, Annals of Thoracic SurgeryCitation Excerpt :Unfortunately, further understanding regarding the association between DiGeorge syndrome and late mortality is hindered by the absence of clear explanations for many of the late deaths in our study, which frequently occurred unexpectedly at home or outside hospitals. The need for tracheostomy after congenital heart surgery has been associated with poor long-term outcomes in several studies, especially in patients with complex lesions [16, 17]. In our analysis 1 of 11 patients with tracheostomies died before hospital discharge and 5 suffered late mortality.
Risk factors and outcomes of tracheostomy after prolonged mechanical ventilation in pediatric patients with heart disease
2018, Progress in Pediatric CardiologyCitation Excerpt :We identified potential risk factors for tracheostomy based on the relevant literature and our experience and compared these between patients with and without tracheostomy. Our analysis included the following factors: age in days at the initiation of mechanical ventilation [16], sex, pediatric intensive care unit admission body weight, genetic abnormalities [16–18], cardiopulmonary resuscitation, central nervous system complications (including cerebral hemorrhage, cerebral infarction, hypoxic encephalopathy, and convulsions) [10], respiratory complications (including upper airway obstruction, vocal cord paralysis, subglottic stenosis, tracheomalacia, bronchomalacia, phrenic nerve paralysis, pneumothorax, and episodes of pulmonary aspiration) [10–12,18], extubation failure (defined as reintubation within 48 h of a planned extubation), single ventricle anatomy [19], hypoplastic left heart syndrome and its variants, cardiac surgery, multiple (≥2) surgeries before tracheostomy [13], use of extracorporeal membrane oxygenation [18], peak serum level of brain natriuretic peptide before tracheostomy [11,20], diagnosis of pulmonary hypertension (based on echocardiogram results or the use of nitric oxide inhalation or sildenafil citrate), chylothorax, diagnosed or suspected infection (defined by the use of antibiotics), pediatric index of mortality 2 score (a scale for predicting mortality in patients admitted to the pediatric intensive care unit) [21], fraction of inspired oxygen and mean airway pressure ≥ 10 cmH2O after 14 days of mechanical ventilation, and vasoactive-inotrope score after 14 days of mechanical ventilation [22,23]. Categorical variables were evaluated using the chi-square or Fisher's exact test as appropriate.