title: Tracheostomy After Operations for Congenital Heart Disease: An Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.
abstract: BACKGROUND
  Information concerning tracheostomy after operations for congenital heart disease has come primarily from single-center reports. We aimed to describe the epidemiology and outcomes associated with postoperative tracheostomy in a multi-institutional registry.
  
  
  METHODS
  The Society of Thoracic Surgeons Congenital Heart Database (2000 to 2014) was queried for all index operations with the adverse event "postoperative tracheostomy" or "respiratory failure, requiring tracheostomy." Patients with preoperative tracheostomy or weighing less than 2.5 kg undergoing isolated closure of patent ductus arteriosus were excluded. Trends in tracheostomy incidence over time from January 2000 to June 2014 were analyzed with a Cochran-Armitage test. The patient characteristics associated with operative mortality were analyzed for January 2010 to June 2014, including deaths occurring up to 6 months after transfer of patients to long-term care facilities.
  
  
  RESULTS
  From 2000 to 2014, the incidence of tracheostomy after operations for congenital heart disease increased from 0.11% in 2000 to a high of 0.76% in 2012 (p < 0.0001). From 2010 to 2014, 648 patients underwent tracheostomy. The median age at operation was 2.5 months (25th, 75th percentile: 0.4, 7). Prematurity (n = 165, 26%), genetic abnormalities (n = 298, 46%), and preoperative mechanical ventilation (n = 275, 43%) were common. Postoperative adverse events were also common, including cardiac arrest (n = 131, 20%), extracorporeal support (n = 87, 13%), phrenic or laryngeal nerve injury (n = 114, 18%), and neurologic deficit (n = 51, 8%). The operative mortality was 25% (n = 153).
  
  
  CONCLUSIONS
  Tracheostomy as an adverse event of operations for congenital heart disease remains rare but has been increasingly used over the past 15 years. This trend and the considerable mortality risk among patients requiring postoperative tracheostomy support the need for further research in this complex population.
authors.affiliation: Riley Hospital for Children, Indianapolis, Indiana; Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: cmastrop@iupui.edu.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Mastropietro
authors.affiliation: Riley Hospital for Children, Indianapolis, Indiana; Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Benneyworth
authors.affiliation: Riley Hospital for Children, Indianapolis, Indiana; Division of Cardiovascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Mark
authors.initials: M
authors.lastname: Turrentine
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors.forename: Amelia S
authors.initials: AS
authors.lastname: Wallace
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, North Carolina.
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hornik
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
mesh_terms: D002916:Chylothorax / Q000453:epidemiology / Q000209:etiology; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality; D006330:Heart Defects, Congenital / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D014139:Tracheostomy / Q000706:statistics & numerical data / Q000639:trends