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Original Investigation |

Tracheostomy Placement in Children Younger Than 2 Years 30-Day Outcomes Using the National Surgical Quality Improvement Program Pediatric

Justin B. Mahida, MD, MBA1,2; Lindsey Asti, MPH2; Emily F. Boss, MD, MPH3,4; Rahul K. Shah, MD5; Katherine J. Deans, MD, MHSc1,2; Peter C. Minneci, MD, MHSc1,2; Kris R. Jatana, MD6,7
[+] Author Affiliations
1Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, Ohio
2Center for Surgical Outcomes Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
3Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland
4Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
5Division of Otolaryngology, Children’s National Medical Center, Washington, DC
6Department of Otolaryngology–Head and Neck Surgery, Nationwide Children’s Hospital, Columbus, Ohio
7Department of Otolaryngology–Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus
JAMA Otolaryngol Head Neck Surg. 2016;142(3):241-246. doi:10.1001/jamaoto.2015.3302.
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Importance  Analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric demonstrated that the highest contribution to composite morbidity in otolaryngology is seen in children younger than 2 years undergoing tracheostomy.

Objective  To determine predictive factors for complications following tracheostomy placement in patients younger than 2 years that, if targeted for reduction in quality initiatives, might result in improved surgical outcomes.

Design, Setting, and Participants  The NSQIP Pediatric reports predefined 30-day postoperative outcomes for surgical cases from participating institutions for quality improvement. All 206 cases of elective tracheostomy performed in children younger than 2 years from 2012 to 2013 among 61 participating institutions and documented in the NSQIP Pediatric public use file were included. Data analysis was conducted from December 1, 2014, to June 30, 2015.

Interventions  Surgical placement of tracheostomy in children younger than 2 years.

Main Outcomes and Measures  Demographics and clinical and perioperative characteristics for children who did and did not experience a major complication from elective tracheostomy were compared. Continuous variables were compared using Wilcoxon rank sum tests and categorical variables were compared using Pearson χ2 tests or Fisher exact tests where appropriate. A logistic regression model was fit to identify adjusted odds ratios (aORs) with 95% CIs of preoperative factors predictive of occurrence of a major complication.

Results  Of the 206 children younger than 2 years who underwent tracheostomy, 50 (24.3%) experienced a major complication within 30 days. The most common complications were pneumonia (16 [7.8%]), postoperative sepsis (12 [5.8%]), death (12 [5.8%]), and deep or organ space surgical site infections (8 [3.9%]). Neonatal age (aOR, 2.38; 95% CI, 1.06-5.37; P = .04), intraventricular hemorrhage (aOR, 2.72; 95% CI, 1.01-7.32; P = .048), and comorbid cardiac risk factors (relative to none: minor risk factors, aOR, 2.94; 95% CI, 1.19-7.24; major or severe risk factors, aOR, 1.31; 95% CI, 0.44-3.84; P = .04 for all cardiac risk factors) were independently predictive of major complications.

Conclusions and Relevance  Young children undergoing tracheostomy tube placement have high rates of morbidity. This analysis identifies the need for additional procedure-specific outcome variables and improved variable definitions to incorporate into a detailed module for NSQIP Pediatric that will more effectively promote national, specialty-specific targeted quality improvement efforts.

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