Characterizing mortality in pediatric tracheostomy patients

Jamie Lauren Funamura, Sonia Yuen, Kosuke Kawai, Ozgul Gergin, Eelam Adil, Reza Rahbar, Karen Watters

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objectives/Hypothesis: To assess the longitudinal risk of death following tracheostomy in the pediatric age group. Study Design: Retrospective cohort study. Methods: Hospital records of 513 children (≤18 years) at a tertiary care children's hospital who underwent tracheostomy between 1984 and 2015 were reviewed. The primary outcome measure was time from tracheostomy to death. Secondary patient demographic and clinical characteristics were assessed, with likelihood of death using χ2 tests and the Cox proportional hazards model. Results: Median age at time of tracheostomy was 0.8 years (interquartile range, 0.3-5.2 years).The highest mortality rate (27.8%) was observed in patients in the 13- to 18-year-old age category; their mortality rate was significantly higher when compared to the lowest mortality risk group patients (age 1-4 years, P = .031). Timing of death was evenly distributed: <90 days (37.6%), 90 days to 1 year (27.1%), and >1 year after tracheostomy (35.3%). Patients who underwent tracheostomy for cardiopulmonary disease had an increased risk of mortality compared with airway obstruction (adjusted hazard ratio: 3.53, 95% confidence interval: 1.72-7.24, P < .001) and other indications. Adjusted hazard ratios for bronchopulmonary dysplasia (BPD) and congenital heart disease (CHD) were 2.63 and a 2.61, respectively (P < .001). Conclusions: Pediatric patients with tracheostomy have a high mortality rate, with an increased risk of death associated with a cardiopulmonary indication for undergoing tracheostomy. The majority of deaths occur after the index hospitalization during which the tracheostomy was performed. BPD and CHD are independent predictors of mortality in pediatric tracheostomy patients.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StateAccepted/In press - 2016
Externally publishedYes

Fingerprint

Tracheostomy
Pediatrics
Mortality
Bronchopulmonary Dysplasia
Heart Diseases
Age Groups
Hospital Records
Airway Obstruction
Tertiary Healthcare
Proportional Hazards Models
Hospitalization
Cohort Studies
Retrospective Studies
Demography
Outcome Assessment (Health Care)
Confidence Intervals

Keywords

  • Bronchopulmonary dysplasia
  • Congenital heart disease
  • Pediatric tracheostomy
  • Tracheostomy indication

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Funamura, J. L., Yuen, S., Kawai, K., Gergin, O., Adil, E., Rahbar, R., & Watters, K. (Accepted/In press). Characterizing mortality in pediatric tracheostomy patients. Laryngoscope. https://doi.org/10.1002/lary.26361

Characterizing mortality in pediatric tracheostomy patients. / Funamura, Jamie Lauren; Yuen, Sonia; Kawai, Kosuke; Gergin, Ozgul; Adil, Eelam; Rahbar, Reza; Watters, Karen.

In: Laryngoscope, 2016.

Research output: Contribution to journalArticle

Funamura, Jamie Lauren ; Yuen, Sonia ; Kawai, Kosuke ; Gergin, Ozgul ; Adil, Eelam ; Rahbar, Reza ; Watters, Karen. / Characterizing mortality in pediatric tracheostomy patients. In: Laryngoscope. 2016.
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abstract = "Objectives/Hypothesis: To assess the longitudinal risk of death following tracheostomy in the pediatric age group. Study Design: Retrospective cohort study. Methods: Hospital records of 513 children (≤18 years) at a tertiary care children's hospital who underwent tracheostomy between 1984 and 2015 were reviewed. The primary outcome measure was time from tracheostomy to death. Secondary patient demographic and clinical characteristics were assessed, with likelihood of death using χ2 tests and the Cox proportional hazards model. Results: Median age at time of tracheostomy was 0.8 years (interquartile range, 0.3-5.2 years).The highest mortality rate (27.8{\%}) was observed in patients in the 13- to 18-year-old age category; their mortality rate was significantly higher when compared to the lowest mortality risk group patients (age 1-4 years, P = .031). Timing of death was evenly distributed: <90 days (37.6{\%}), 90 days to 1 year (27.1{\%}), and >1 year after tracheostomy (35.3{\%}). Patients who underwent tracheostomy for cardiopulmonary disease had an increased risk of mortality compared with airway obstruction (adjusted hazard ratio: 3.53, 95{\%} confidence interval: 1.72-7.24, P < .001) and other indications. Adjusted hazard ratios for bronchopulmonary dysplasia (BPD) and congenital heart disease (CHD) were 2.63 and a 2.61, respectively (P < .001). Conclusions: Pediatric patients with tracheostomy have a high mortality rate, with an increased risk of death associated with a cardiopulmonary indication for undergoing tracheostomy. The majority of deaths occur after the index hospitalization during which the tracheostomy was performed. BPD and CHD are independent predictors of mortality in pediatric tracheostomy patients.",
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AU - Yuen, Sonia

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AU - Rahbar, Reza

AU - Watters, Karen

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N2 - Objectives/Hypothesis: To assess the longitudinal risk of death following tracheostomy in the pediatric age group. Study Design: Retrospective cohort study. Methods: Hospital records of 513 children (≤18 years) at a tertiary care children's hospital who underwent tracheostomy between 1984 and 2015 were reviewed. The primary outcome measure was time from tracheostomy to death. Secondary patient demographic and clinical characteristics were assessed, with likelihood of death using χ2 tests and the Cox proportional hazards model. Results: Median age at time of tracheostomy was 0.8 years (interquartile range, 0.3-5.2 years).The highest mortality rate (27.8%) was observed in patients in the 13- to 18-year-old age category; their mortality rate was significantly higher when compared to the lowest mortality risk group patients (age 1-4 years, P = .031). Timing of death was evenly distributed: <90 days (37.6%), 90 days to 1 year (27.1%), and >1 year after tracheostomy (35.3%). Patients who underwent tracheostomy for cardiopulmonary disease had an increased risk of mortality compared with airway obstruction (adjusted hazard ratio: 3.53, 95% confidence interval: 1.72-7.24, P < .001) and other indications. Adjusted hazard ratios for bronchopulmonary dysplasia (BPD) and congenital heart disease (CHD) were 2.63 and a 2.61, respectively (P < .001). Conclusions: Pediatric patients with tracheostomy have a high mortality rate, with an increased risk of death associated with a cardiopulmonary indication for undergoing tracheostomy. The majority of deaths occur after the index hospitalization during which the tracheostomy was performed. BPD and CHD are independent predictors of mortality in pediatric tracheostomy patients.

AB - Objectives/Hypothesis: To assess the longitudinal risk of death following tracheostomy in the pediatric age group. Study Design: Retrospective cohort study. Methods: Hospital records of 513 children (≤18 years) at a tertiary care children's hospital who underwent tracheostomy between 1984 and 2015 were reviewed. The primary outcome measure was time from tracheostomy to death. Secondary patient demographic and clinical characteristics were assessed, with likelihood of death using χ2 tests and the Cox proportional hazards model. Results: Median age at time of tracheostomy was 0.8 years (interquartile range, 0.3-5.2 years).The highest mortality rate (27.8%) was observed in patients in the 13- to 18-year-old age category; their mortality rate was significantly higher when compared to the lowest mortality risk group patients (age 1-4 years, P = .031). Timing of death was evenly distributed: <90 days (37.6%), 90 days to 1 year (27.1%), and >1 year after tracheostomy (35.3%). Patients who underwent tracheostomy for cardiopulmonary disease had an increased risk of mortality compared with airway obstruction (adjusted hazard ratio: 3.53, 95% confidence interval: 1.72-7.24, P < .001) and other indications. Adjusted hazard ratios for bronchopulmonary dysplasia (BPD) and congenital heart disease (CHD) were 2.63 and a 2.61, respectively (P < .001). Conclusions: Pediatric patients with tracheostomy have a high mortality rate, with an increased risk of death associated with a cardiopulmonary indication for undergoing tracheostomy. The majority of deaths occur after the index hospitalization during which the tracheostomy was performed. BPD and CHD are independent predictors of mortality in pediatric tracheostomy patients.

KW - Bronchopulmonary dysplasia

KW - Congenital heart disease

KW - Pediatric tracheostomy

KW - Tracheostomy indication

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