Author(s)
Grace X. Tan, MD1
Jonathan M. Walsh, MD1
David E. Tunkel, MD1
Daniel S. Rhee, MD MPH2
Alejandro V. Garcia, MD2
Kris R. Jatana, MD3
Emily F. Boss, MD MPH1
Affiliation(s)
1Otolaryngology -- Head and Neck Surgery, Johns Hopkins Univ. Sch. of Med., Baltimore, MD, 2General Surgery, Johns Hopkins Univ. Sch. of Med., Baltimore, MD, 3Otolaryngology -- Head and Neck Surgery, The Ohio State Univ. & Nationwide Children’s Hosp., Columbus, OH.
Abstract:
Introduction: Although the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) provides indicators of perioperative safety 30 days after surgery, it is unknown whether these events predict long-term outcomes. We aim to determine whether factors collected through NSQIP-P and 30-day adverse events impact long-term outcomes in children < 2 years that undergo tracheostomy.
Methods: We conducted a retrospective review of children < 2 years in NSQIP who underwent tracheostomy (CPT 31600, 31601, 31610) at our institution between January 2012 and May 2018. Patient demographics, clinical/surgical characteristics, and 30-day perioperative adverse events were collected. On long-term follow-up determined by medical record review, total hospital length of stay, intended decannulation, and death were also determined. Fisher’s exact test and multivariate logistic regression were performed to determine risk factors for 30-day and long-term outcomes.
Results: 24 children were included. Average age was 4.26 ± 3.12 months; 14 (58.3%) were male, 14 (58.3%) were non-white, 8 (33.3%) were premature. 7 (29.2%) patients had 30-day perioperative adverse events. 10 (41.7%) required mechanical ventilation > 30 days; 9 (37.5%) had a total length of stay of > 90 days. At long term follow-up, there were 6 (25.0%) deaths and 8 (33.3%) intended decannulations. 30-day perioperative adverse events (odds ratio [OR] 8.12, p = 0.06) and mechanical ventilation > 30 days (OR 52.0, p < 0.01) were associated with length of stay > 90 days, but not associated with tracheostomy dependence or death at long-term follow-up. Pre-operative structural central nervous system (CNS) abnormalities were associated with death at long-term follow up (OR 17.0, p=0.04), but not upper airway abnormalities or chronic lung disease.
Conclusion: In this small cohort, preexisting CNS abnormalities predicted long-term outcomes of tracheostomy, and 30-day perioperative events were associated with increased length of stay, but not tracheostomy dependence or death at long-term follow-up. This may be useful in preoperative counselling as well as optimization of perioperative care. Focus of NSQIP on procedure-specific outcomes may allow more insight into predictors of long-term outcomes.