title: Tracheostomy in Infants With Congenital Heart Disease: A Nationwide Population-Based Study in Taiwan.
abstract: BACKGROUND
  This study aimed to use the National Health Insurance Research Database in Taiwan to examine the risk factors for tracheostomy in infants with congenital heart disease (CHD) and to evaluate the associated mortality risk in those who received a tracheostomy.
  
  
  METHODS
  The study was conducted between 2000 and 2011 with infants assigned to either a CHD group (34,943 subjects) or an age- and sex-matched control group (136,600 subjects). We then performed descriptive, logistic regression, Kaplan-Meier, and Cox regression analyses for the investigation.
  
  
  RESULTS
  Infants with CHD had an increased risk of tracheostomy (adjusted hazard ratio [HR], 6.67, 95% CI 4.40-10.10). Congenital airway anomaly (adjusted odds ratio [OR], 15.25, 95% CI 10.56-22.02), neuromuscular impairment (adjusted OR 6.24, 95% CI 4.35-8.94), and time (0-3 y) after CHD diagnosis (adjusted OR 3.27, 95% CI 2.19-4.89) were most highly correlated with tracheostomy placement. The mortality risk was increased in infants with CHD and a tracheostomy even after adjusting for confounders (adjusted HR 3.88, 95% CI 2.96-5.08). Mortality risk (adjusted HR and 95% CI) increased by 2.06 (1.56-2.71), 7.19 (2.42-21.38), and 14.76 (1.46-149.69) after 0-3, 4-7, and 8-11 y of follow-up, respectively.
  
  
  CONCLUSIONS
  Infants with CHD had an increased risk of undergoing tracheostomy. The mortality risk is significantly increased in infants with CHD and tracheostomy, and the risk increases progressively with time. Further studies are warranted to clarify the mechanisms underlying the risks associated with tracheostomy.
authors.affiliation: Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan and the Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan. Institute of Public Health and Community Medicine Research Center, National, Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan and the Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan. Institute of Emergency and Critical Care Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Mei-Jy
authors.initials: MJ
authors.lastname: Jeng
authors.affiliation: Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan and the Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Pei-Chen
authors.initials: PC
authors.lastname: Tsao
authors.affiliation: Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan and the Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan. pschou@ym.edu.tw wjsoong@vghtpe.gov.tw.
authors.forename: Wen-Jue
authors.initials: WJ
authors.lastname: Soong
authors.affiliation: Institute of Public Health and Community Medicine Research Center, National, Yang-Ming University School of Medicine, Taipei, Taiwan. pschou@ym.edu.tw wjsoong@vghtpe.gov.tw.
authors.forename: Pesus
authors.initials: P
authors.lastname: Chou
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors; D014139:Tracheostomy / Q000401:mortality*
keywords: congenital heart disease; hazard ratio; national health insurance; national health insurance research database; odds ratio; tracheostomy