To determine the rate of tracheostomy-related complications in pediatric patients from nationally representative databases.
Study Design
Cross-sectional analysis.
Setting
2016 Kids’ Inpatient Database and 2016 Nationwide Readmission Database.
Methods
All pediatric tracheostomy procedures were included. Complication type, admission outcomes, and readmission rates were recorded with a logistic regression analysis to determine patient characteristics associated with complications.
Results
An estimated 5309 tracheostomies were performed among pediatric patients in 2016, 8% (n = 432) of whom developed tracheostomy-related complications. This group was younger (4.7 vs 8.7 years, P < .001) and required longer hospital admissions (68.7 vs 33.2 days, P < .001) than children without tracheostomy-related complications. Mean costs ($459,324 vs $397,937, P < .001) and mean total charges ($1,573,964 vs $1,099,347, P < .001) were increased if a tracheostomy-related complication occurred. These events occurred more often in those with bronchopulmonary dysplasia (24% vs 12%, P < .001), heart disease (24% vs 12%, P = .001), gastroesophageal reflux disease (31% vs 19%, P < .001), short gestational age (24% vs 14%, P < .001), and subglottic stenosis (9.9% vs 5.4%, P = .001). The estimated 30-day readmission rate was 24% (SE, 1.7%) but did not increase after tracheostomy complications (27% vs 15%, P = .04). Tracheostomy-related complications were predicted by gastroesophageal reflux disease (odds ratio [OR], 1.50; 95% CI, 1.14-1.97; P = .004), younger age (OR, 1.12; 95% CI, 1.04-1.22; P = .002), and lengthier hospitalization (OR, 1.00; 95% CI, 1.00-1.01; P < .001) on multiple logistic regression analysis.
Conclusion
Tracheostomy-related complications occur in approximately 8% of pediatric patients and are higher in younger children or those with longer admission lengths. These data have implications for benchmarking standards of posttracheostomy complications across institutions.
SakaiMKouYFShahGBJohnsonRF.Tracheostomy demographics and outcomes among pediatric patients ages 18 years or younger—United States 2012. Laryngoscope. 2019;129(7):1706-1711.
2.
PereiraKDMacGregorARMcDuffieCMMitchellRB.Tracheostomy in preterm infants: current trends. Arch Otolaryngol Head Neck Surg. 2003;129(12):1268-1271.
3.
MitchellRBHusseyHMSetzenG, et al. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg. 2013;148(1):6-20.
4.
MehtaABSyedaSNBajpayeeLCookeCRWalkeyAJWienerRS.Trends in tracheostomy for mechanically ventilated patients in the United States, 1993-2012. Am J Respir Crit Care Med. 2015;192(4):446-454.
5.
SpataroEDurakovicNKallogjeriDNussenbaumB.Complications and 30-day hospital readmission rates of patients undergoing tracheostomy: a prospective analysis. Laryngoscope. 2017;127(12):2746-2753.
6.
ShahRKLanderLBerryJGNussenbaumBMeratiARobersonDW.Tracheotomy outcomes and complications: a national perspective. Laryngoscope. 2012;122(1):25-29.
7.
PereiraKDMacGregorARMitchellRB.Complications of neonatal tracheostomy: a 5-year review. Otolaryngol Head Neck Surg. 2004;131(6):810-813.
8.
KlotzRProbstPDeiningerM, et al. Percutaneous versus surgical strategy for tracheostomy: a systematic review and meta-analysis of perioperative and postoperative complications. Langenbecks Arch Surg. 2018;403(2):137-149.
9.
KligermanMPSaraswathulaASethiRKDiviV.Tracheostomy complications in the emergency department: a national analysis of 38,271 cases. ORL J Otorhinolaryngol Relat Spec. 2020;82(2):106-114.
10.
JenkinsRMorrisNAHaacB, et al. Inpatient complications predict tracheostomy better than admission variables after traumatic brain injury. Neurocrit Care. 2019;30(2):387-393.
11.
ItamotoCHLimaBTSatoJFujitaRR.Indications and complications of tracheostomy in children. Braz J Otorhinolaryngol. 2010;76(3):326-331.
12.
HalumSLTingJYPlowmanEK, et al. A multi-institutional analysis of tracheotomy complications. Laryngoscope. 2012;122(1):38-45.
13.
Fernandez-BussySMahajanBFolchECaviedesIGuerreroJMajidA.Tracheostomy tube placement: early and late complications. J Bronchology Interv Pulmonol. 2015;22(4):357-364.
14.
CramerJDGraboyesEMBrennerMJ.Mortality associated with tracheostomy complications in the United States: 2007-2016. Laryngoscope. 2019;129(3):619-626.
15.
CiprianoAMaoMLHonHH, et al. An overview of complications associated with open and percutaneous tracheostomy procedures. Int J Crit Illn Inj Sci. 2015;5(3):179-188.
16.
BarreraSCSanfordEJAmmermanSBFerrellJKSimpsonCBDominguezLM.Postoperative complications in obese patients after tracheostomy. OTO Open. 2020;4(3):2473974X20953090.
17.
McGrathBALynchJBonventoB, et al. Evaluating the quality improvement impact of the Global Tracheostomy Collaborative in four diverse NHS hospitals. BMJ Qual Improv Rep. 2017;6(1):bmjqir.u220636.w7996.
18.
OngTLiuCCElderL, et al. The Trach Safe Initiative: a quality improvement initiative to reduce mortality among pediatric tracheostomy patients. Otolaryngol Head Neck Surg. 2020;163(2):221-231.
19.
BedwellJRPandianVRobersonDWMcGrathBACameronTSBrennerMJ.Multidisciplinary tracheostomy care: how collaboratives drive quality improvement. Otolaryngol Clin North Am. 2019;52(1):135-147.
20.
SarehSToppenWUgarteR, et al. Impact of early tracheostomy on outcomes following cardiac surgery: a national analysis. Ann Thorac Surg. 2021;111(5):1537-1544.
21.
LewisCWCarronJDPerkinsJASieKCFeudtnerC.Tracheotomy in pediatric patients: a national perspective. Arch Otolaryngol Head Neck Surg. 2003;129(5):523-529.
22.
DasPZhuHShahRKRobersonDWBerryJSkinnerML.Tracheotomy-related catastrophic events: results of a national survey. Laryngoscope. 2012;122(1):30-37.
23.
TyreePTLindBKLaffertyWE.Challenges of using medical insurance claims data for utilization analysis. Am J Med Qual. 2006;21(4):269-275.
24.
MathewsSCMakaryMA.Billing quality is medical quality. JAMA. 2020;323(5):409-410.
25.
EislerLHuangGLeeKM, et al. Identification of perioperative pulmonary aspiration in children using quality assurance and hospital administrative billing data. Paediatr Anaesth. 2018;28(3):218-225.
26.
Agency for Healthcare Research and Quality. Introduction to the HCUP Kids’ Inpatient Database (KID) 2016. Healthcare Cost and Utilization Project; 2018.
27.
Agency for Healthcare Research and Quality. Introduction to the HCUP Nationwide Readmission Database (NRD) 2010-2018. Healthcare Cost and Utilization Project; 2020.
28.
WangCSKouYFShahGBMitchellRBJohnsonRF.Tracheostomy in extremely preterm neonates in the United States: a cross-sectional analysis. Laryngoscope. 2020;130(8):2056-2062.
29.
BerryJGGrahamRJRobersonDW, et al. Patient characteristics associated with in-hospital mortality in children following tracheotomy. Arch Dis Child. 2010;95(9):703-10.
30.
MullerRGMamidalaMPSmithSHSmithASheynA.Incidence, epidemiology, and outcomes of pediatric tracheostomy in the United States from 2000 to 2012. Otolaryngol Head Neck Surg. 2019;160(2):332-338.
31.
Agency for Healthcare Research and Quality. Overview of the Kids’ Inpatient Database (KID): Healthcare Cost and Utilization Project (HCUP). Accessed June 1, 2021. http://www.hcup-us.ahrq.gov/kidoverview.jsp
32.
Agency for Healthcare Research and Quality. Overview of the Nationwide Readmissions Database (NRD): Healthcare Cost and Utilization Project (HCUP). Accessed June 1, 2021. http://www.hcup-us.ahrq.gov/nrdoverview.jsp
33.
HeronM.Deaths: leading causes for 2017. Natl Vital Stat Rep. 2019;68(6):1-77.
34.
CarronJDDerkayCSStropeGLNosonchukJEDarrowDH.Pediatric tracheotomies: changing indications and outcomes. Laryngoscope. 2000;110(7):1099-1104.
35.
CarrMMPojeCPKingstonLKielmaDHeardC.Complications in pediatric tracheostomies. Laryngoscope. 2001;111(11):1925-1928.
36.
MahadevanMBarberCSalkeldLDouglasGMillsN.Pediatric tracheotomy: 17 year review. Int J Pediatr Otorhinolaryngol. 2007;71(12):1829-1835.
37.
D’SouzaJNLeviJRParkDShahUK.Complications following pediatric tracheotomy. JAMA Otolaryngol Head Neck Surg. 2016;142(5):484-488.
38.
DavidsonCJacobBBrownA, et al. Perioperative outcomes after tracheostomy placement among complex pediatric patients. Laryngoscope. 2021;131(8):E2469-E2474.
39.
LiaoKChorneySRBrownA, et al. The impact of socioeconomic disadvantage on pediatric tracheostomy outcomes. Laryngoscope. Published online April 16, 2021. doi:10.1002/lary.29576
40.
PereiraKDShaiganyKZurKB, et al. Tracheostomy in the extremely premature neonate: a multi-institutional study. Otolaryngol Head Neck Surg. 2020;162(4):559-565.
41.
FriesenTLZamoraSMRahmanianRBundogjiNBriggerMT.Predictors of pediatric tracheostomy outcomes in the United States. Otolaryngol Head Neck Surg. 2020;163(3):591-599.
ChorneySRZurKBBuziA.Reflux as a risk factor for morbidity after pediatric tonsillectomy: a national cohort of inpatients. Laryngoscope. 2021;131(4):907-910.
44.
SopoSMRadzikDCalvaniM.Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD? A systematic review. J Investig Allergol Clin Immunol. 2009;19(1):1-5.
45.
LightdaleJRGremseDA.Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics. 2013;131(5):e1684-e1695.
46.
RosnerEMastropietroCW.Prior cardiac surgery is independently associated with decreased survival following infant tracheostomy. Respir Care. 2015;60(1):47-55.
47.
FunamuraJLYuenSKawaiK, et al. Characterizing mortality in pediatric tracheostomy patients. Laryngoscope. 2017;127(7):1701-1706.
48.
OrtmannLAManimtimWMLachicaCI.Outcomes of tracheostomy in children requiring surgery for congenital heart disease. Pediatr Cardiol. 2017;38(2):296-301.
49.
RawalRBFarquharDRKilpatrickLADrakeAFZdanskiCJ.Considering a weight criterion for neonatal tracheostomy: an analysis of the ACS NSQIP-P. Laryngoscope. 2019;129(2):500-505.
