title: Tracheostomy Placement in Children Younger Than 2 Years: 30-Day Outcomes Using the National Surgical Quality Improvement Program Pediatric.
abstract: OBJECTIVE
  Analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric demonstrated that the highest contribution to composite morbidity in otolaryngology is seen in children younger than 2 years undergoing tracheostomy.
  
  
  OBJECTIVE
  To determine predictive factors for complications following tracheostomy placement in patients younger than 2 years that, if targeted for reduction in quality initiatives, might result in improved surgical outcomes.
  
  
  METHODS
  The NSQIP Pediatric reports predefined 30-day postoperative outcomes for surgical cases from participating institutions for quality improvement. All 206 cases of elective tracheostomy performed in children younger than 2 years from 2012 to 2013 among 61 participating institutions and documented in the NSQIP Pediatric public use file were included. Data analysis was conducted from December 1, 2014, to June 30, 2015.
  
  
  METHODS
  Surgical placement of tracheostomy in children younger than 2 years.
  
  
  METHODS
  Demographics and clinical and perioperative characteristics for children who did and did not experience a major complication from elective tracheostomy were compared. Continuous variables were compared using Wilcoxon rank sum tests and categorical variables were compared using Pearson χ2 tests or Fisher exact tests where appropriate. A logistic regression model was fit to identify adjusted odds ratios (aORs) with 95% CIs of preoperative factors predictive of occurrence of a major complication.
  
  
  RESULTS
  Of the 206 children younger than 2 years who underwent tracheostomy, 50 (24.3%) experienced a major complication within 30 days. The most common complications were pneumonia (16 [7.8%]), postoperative sepsis (12 [5.8%]), death (12 [5.8%]), and deep or organ space surgical site infections (8 [3.9%]). Neonatal age (aOR, 2.38; 95% CI, 1.06-5.37; P = .04), intraventricular hemorrhage (aOR, 2.72; 95% CI, 1.01-7.32; P = .048), and comorbid cardiac risk factors (relative to none: minor risk factors, aOR, 2.94; 95% CI, 1.19-7.24; major or severe risk factors, aOR, 1.31; 95% CI, 0.44-3.84; P = .04 for all cardiac risk factors) were independently predictive of major complications.
  
  
  CONCLUSIONS
  Young children undergoing tracheostomy tube placement have high rates of morbidity. This analysis identifies the need for additional procedure-specific outcome variables and improved variable definitions to incorporate into a detailed module for NSQIP Pediatric that will more effectively promote national, specialty-specific targeted quality improvement efforts.
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio2Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Mahida
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Asti
authors.affiliation: Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland4Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Emily F
authors.initials: EF
authors.lastname: Boss
authors.affiliation: Division of Otolaryngology, Children's National Medical Center, Washington, DC.
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Shah
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio2Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio2Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Nationwide Children's Hospital, Columbus, Ohio7Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus.
authors.forename: Kris R
authors.initials: KR
authors.lastname: Jatana
mesh_terms: D002648:Child; D002675:Child, Preschool; D017558:Elective Surgical Procedures / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009017:Morbidity / Q000639:trends; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011379:Prognosis; D015397:Program Evaluation / Q000379:methods*; D058996:Quality Improvement; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy / Q000592:standards*; D014481:United States / Q000453:epidemiology