title: Outcomes of Tracheostomy in Children Requiring Surgery for Congenital Heart Disease.
abstract: Outcomes after discharge in children requiring tracheostomy after cardiac surgery have not been fully described. A retrospective, single-center study was performed on all children <18 years of age requiring both tracheostomy and surgery for congenital heart disease from January 2002 to May 2015. Forty-six tracheostomies were placed after surgery and four before. Single-ventricle anatomy was present in 12 (33%) patients. Incidence of tracheostomy after heart surgery increased from 0.8% the first half of the study period to 2% the second half. Median time between cardiac surgery and tracheostomy was 58 days. The most common indication for tracheostomy was multifactorial (30%) followed by airway malacia (22%). Median length to follow-up for survivors was 3.9 years (range 0.4-11.8 years). Survival to hospital discharge was 72%, and intermediate survival was 48%. Survival in those with systemic to pulmonary artery shunts at the time of tracheostomy was 22% compared to 59% for those with biventricular anatomy. Heart failure and multiple indications for tracheostomy were associated with worse outcome. There was no difference in survival for those discharged with a ventilator compared to those that were not. The most common cause of death after discharge was tracheostomy tube dislodgement/obstruction, accounting for 5 of 11 that died. Survival with a tracheostomy after cardiac surgery is poor, and children with systemic to pulmonary artery shunts are at especially high risk of death.
authors.affiliation: Pediatric Critical Care, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA. lortmann@cmh.edu.
authors.forename: Laura A
authors.identifier: http://orcid.org/0000-0002-6619-7091
authors.initials: LA
authors.lastname: Ortmann
authors.affiliation: Neonatology, Children's Mercy Hospital, Kansas City, MO, USA.
authors.forename: Winston M
authors.initials: WM
authors.lastname: Manimtim
authors.affiliation: Neonatology, Children's Mercy Hospital, Kansas City, MO, USA.
authors.forename: Charisse I
authors.initials: CI
authors.lastname: Lachica
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects*
keywords: Congenital heart defect; Mechanical ventilation; Outcomes; Pediatrics; Thoracic surgery; Tracheostomy