title: Prior cardiac surgery is independently associated with decreased survival following infant tracheostomy.
abstract: BACKGROUND
  Previous reports have demonstrated that prior cardiac surgery is independently associated with in-hospital mortality after infant tracheostomy. We aimed to determine whether these infants would continue to be at increased risk for death following hospital discharge.
  
  
  METHODS
  A retrospective review was performed on subjects < 2 y of age who recovered from tracheostomy in the pediatric ICU at our institution between January 2007 and December 2011, with follow-up to December 2013. Survival to 1 y following tracheostomy was the primary outcome variable for the study. Multivariate Cox regression analysis was then performed to determine independent risk factors for death after infant tracheostomy.
  
  
  RESULTS
  Forty-two subjects met inclusion criteria, 18 of whom had undergone prior cardiac surgery. Twenty-six subjects (62%) were alive at 1 y post-tracheostomy. Age at tracheostomy, concomitant genetic abnormalities or prematurity, and ventilator dependence at discharge were not statistically different between survivors and those who died. Subjects who died, however, were more likely to have had cardiac surgery prior to tracheostomy (11 [69%] vs 7 [27%], P = .008) and had longer hospital stay (median 3.4 months [interquartile range: 2.6-4.6] vs 2.2 months [interquartile range: 1.1-3.5], P = .045). Multivariate Cox regression analysis revealed only prior cardiac surgery to be independently associated with decreased survival after tracheostomy (hazard ratio 4.7, 95% CI 1.3-16.4, P = .02).
  
  
  CONCLUSIONS
  Prior cardiac surgery is independently associated with decreased survival within 1 y following tracheostomy. Clinicians and families of infants with prior cardiac surgery in whom tracheostomy after cardiac surgery is deemed necessary should consider this risk when planning long-term care.
authors.affiliation: Department of Pediatrics, Division of Critical Care Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rosner
authors.affiliation: Department of Pediatrics, Division of Critical Care Medicine, Riley Hospital for Children/Indiana University School of Medicine, Indianapolis, Indiana. cmastrop@iupui.edu.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Mastropietro
mesh_terms: D000402:Airway Obstruction / Q000601:surgery; D006348:Cardiac Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D055089:Tracheobronchomalacia / Q000601:surgery; D014139:Tracheostomy / Q000401:mortality*
keywords: cardiac surgical procedures; chronic lung injury; congenital; heart defects; mechanical; pediatric; tracheostomy; ventilators