Risk Factors Identified for Moderate, Severe Perioperative Tracheostomy Complications in Infants

by Linda Kossoff •

CLINICAL QUESTION

What are the risk factors for perioperative complications and long-term morbidity in infants from the neonatal intensive care unit (NICU) presenting for a tracheostomy?

BOTTOM LINE

Identified risk factors included intraoperative cardiopulmonary arrest, postoperative cardiopulmonary death, and severe perioperative complications.

BACKGROUND: Forty percent of U.S. pediatric tracheostomies occur in children <1 year of age. Severe and moderate perioperative and long-term complications are associated with tracheostomy placement, with infants at significant risk due to their size and airway anatomy. There is no established risk stratification for infants in the NICU presenting for tracheostomy.

STUDY DESIGN: Retrospective study.

SETTING: Division of Pediatric Otolaryngology, Department of Surgery, Baylor College of Medicine, Texas Children’s Hospital, Houston.

SYNOPSIS: Researchers identified 183 infants in the NICU at a single institution presenting for a tracheostomy from August 2011 to December 2019. Primary outcomes were perioperative complication (classified as severe or moderate) or long-term morbidity. Follow-up periods were 12 and 24 months. The mean age at tracheostomy was 16.9 weeks. Incidence of severe perioperative complications (intraoperative or postoperative cardiopulmonary arrest or death) was 4.4%. Incidence of moderate perioperative complications was 49.7% and included major intraoperative hypoxemia (15.8%), vasopressor support escalation (16.3%), and postoperative systemic infection (26.8%). Approximately 81% had a gastrostomy tube placed at the time of tracheostomy, and 62% were ventilator-dependent for two years post-procedure. The total number of pulmonary hypertensive medication classes preoperatively was associated with severe perioperative complications. A preoperative positive culture and a chest wall deformity were associated with intraoperative cardiopulmonary arrest. Gestational age at birth and preoperative oxygen saturation were associated with postoperative cardiopulmonary death. No preoperative factors were associated with increased incidence of major intraoperative hypoxemia, vasopressor support escalation, postoperative tracheostomy wound complication, and postoperative systemic infection. Study limitations included its single-center, retrospective design.

Citation: Lambert EM, Ramaswamy U, Gowda SH, et al. Perioperative and long-term outcomes in infants undergoing a tracheostomy from a neonatal intensive care unit. Laryngoscope. 2024;134:1945–1954.