Factors associated with early mortality in pediatric tracheostomy placement: a retrospective cohort study.

UNLABELLED

To investigate the factors associated with early mortality and complications in children who receive a tracheostomy placement. This was a retrospective study at a tertiary referral center. Children who underwent tracheostomy between 2012 and 2023 was included. Multivariable logistic regression analysis was performed to identify factors associated with 30-day mortality (primary outcome). Secondary outcome was tracheostomy-related complications. A total of 256 children (median age: 6.7 years, interquartile range [IQR]: 0.5-14; 149 [58%] males) were included. Within 30 days after tracheostomy placement, 28(10.9%) children were deceased. Factors that were associated with 30-day mortality were prematurity (adjusted odds ratio [OR]: 3.16, 95% confidence interval [CI]: 1.9-12.39), age < 12 months (OR: 2.15, 95% CI: 1.93-2.43), American Society of Anesthesiologists class 4 (OR: 2.2, 95% CI: 1.93-3.15), late (> 14 days) placement (OR: 1.75, 95% CI: 1.66-1.89), congenital heart disease (OR: 1.9, 95% CI: 1.5-3.12), heart failure (OR: 4.5, 95% CI: 3.8-13.5), and ventilatory dependency (OR: 3.3, 95% CI: 2.25-9.1). Children who died within 30 days had higher rates of postoperative complications compared to those who survived (85.7% vs. 30.3%, p = 0.001), with minor bleeding being the most prevalent complication (58.3% vs. 27.6%, p = 0.01).

CONCLUSIONS

Numerous factors are associated with an increased likelihood of early mortality following tracheostomy placement. These findings are particularly relevant for planning the timing for tracheostomy among critically ill children and engaging in discussions with caregivers about the heightened risks for mortality and complications of the procedure.

WHAT IS KNOWN

• The prevalence of tracheostomies in children has risen significantly due to major advancements in neonatal and pediatric intensive care treatments. • Nonetheless, the mortality rate among children undergoing tracheostomy remains elevated, with approximately one-third of them experiencing mortality during the same hospital admission in which their tracheostomy is carried out.

WHAT IS NEW

• We hypothesize that certain risk factors may discourage tracheostomy placement, potentially advocating for a more conservative management in carefully selected cases of critically ill children. • In children who underwent tracheostomy placement, the 30-day mortality rate was 10.9%, and the complication rate was 26%. • Prematurity, age < 12 months, American Society of Anesthesiologists class 4, congenital heart disease, heart failure, and ventilatory dependency were associated with a higher likelihood of mortality. These children also exhibited higher rates of postoperative complications. • These findings are particularly relevant for planning the timing for tracheostomy among critically ill children and engaging in discussions with caregivers about the heightened risks for mortality and complications of the procedure.