Comparative impact of COVID-19 infection on tracheostomy patients

PURPOSE

We study outcomes after tracheostomy in COVID-19 positive patients versus COVID-19 negative patients who underwent tracheostomy during the same time frame in an effort to better understand the influence of COVID-19 despite variances in virus strain and treatment practices.

MATERIALS AND METHODS

This is a retrospective cohort study of all Veterans Affairs centers nationwide, using data provided by the Veterans Affairs Informatics and Computing Infrastructure. Our cohort consisted of veteran patients who underwent tracheostomy between March 2020 and September 2022. Patients who tested positive for COVID-19 within three months prior to tracheostomy were compared to patients who had never tested positive for COVID-19.

RESULTS

956 patients were included in the analysis, and nearly 96 % of these patients were male. The COVID-19 positive group spent one more week on the ventilator and experienced lower rates of successful ventilator weaning (hazard ratio 0.74, 95 % confidence interval [0.62, 0.88], P < 0.001). Survival curves were non-proportional, and while the COVID-19 positive group had higher 30-day mortality (relative risk 1.37, 95 % confidence interval [1.09, 1.73], P = 0.007), the COVID-19 negative group had higher long-term mortality.

CONCLUSIONS

Our findings suggest that while infection with COVID-19 has a significant effect on short-term outcomes after tracheostomy, chronic comorbidities seem to have the more enduring impact. In spite of prolonged ventilation and higher short-term mortality, tracheostomy in COVID-19 can be a positive intervention that does not necessarily predestine patients to the same level of long-term morbidity and mortality of typical tracheostomies.

Nationwide tracheostomy among neonatal admissions - A cross-sectional analysis

OBJECTIVE

To describe characteristics and outcomes of infants admitted as neonates requiring tracheostomy placement.

METHODS

A cross-sectional analysis of the Kids' Inpatient Database (KID) between 2003 and 2016 included all children admitted within the first 28 days of life that had a tracheostomy placed prior to discharge. Patient characteristics and surgical outcomes were compared between term (≥37 weeks gestation) and preterm (<37 weeks gestation) infants. A subset analysis for Black or African American neonates was performed given disproportional preterm births.

RESULTS

An estimated 4268 (95% CI: 4123-4414) tracheostomies were performed in infants admitted as a neonate with preterm infants accounting for 47% (1998/4268). Among preterm children, 20% were Black or African American compared to 12% in the term group (P < .001). More preterm infants had bronchopulmonary dysplasia (46% vs. 14%, P < .001), cardiac defects (66% vs. 58%, P < .001) and developed pneumonia, newborn sepsis, or sepsis during admissions (P < .001). Laryngotracheal anomalies (25% vs. 18%, P < .001) and vocal cord paralysis (11% vs. 4.9%, P < .001) were more common in term infants. Median length of stay (LOS) (154 vs. 100 days, P < .001) and total charges ($1,395,106 vs. $917,478, P < .001) were greater among preterm infants. Mortality was no different between groups (13% vs. 15%, P = .07). Characteristics strongly associated with preterm status were newborn sepsis (OR: 2.31, 95% CI: 1.97-2.72, P < .001), bronchopulmonary dysplasia (OR: 2.17, 95% CI: 1.77-2.65, P < .001) and Black or African American race (OR: 1.78, 95% CI: 1.46-2.17, P < .001). The following factors increased among all neonates between the baseline year 2003 to the final study year 2016: complications of care (OR: 1.9, 95% CI: 1.5-2.5, P < .001); sepsis (OR: 4.1, 95% CI: 3.0-5.5, P < .001); congenital cardiac anomalies (OR: 5.8, 95% CI: 4.5-7.4, P < .001); and respiratory failure (OR: 1.9, 95% CI: 1.5-2.4, P < .001). Compared to other races, median LOS and total charges were greater among Black or African American infants.

CONCLUSION

Tracheostomies among preterm infants admitted as neonates reflect a growing and complex group with increased costs and hospitalization lengths. Black or African American children are disproportionately born preterm with higher costs and LOS compared to other racial cohorts. Future work will be necessary to design quality-improvement initiatives to improve outcomes for this vulnerable population.

Pediatric tracheostomies in patients less than 2 years of age: Analysis of complications and long-term follow-up

PURPOSE

Identify variables that are predictive of morbidity and mortality in children under the age of two undergoing tracheostomy and to provide longitudinal data on this patient population.

METHODS

Patients were retrospectively identified using Current Procedural Terminology codes 31600, 31601, 31610 from 2009 to 2016.

RESULTS

Median age at time of tracheostomy was 0.43 years (interquartile range, 0.27-0.61). Patients were followed for a median of 1.39 years (range 0.03-4.25). Overall mortality rate in this cohort was 23.5% with the majority (81.3%) of deaths occurring >30 days following tracheostomy. The most frequently encountered major complication was cardiopulmonary arrest (10.29%) in the short-term follow up period (<30 days) and accidental decannulation (32.81%) during long-term follow up (>30 days). Peristomal skin breakdown was less likely to develop in patients who did not receive paralytics following tracheostomy. Most patients (54.4%) were discharged to home following initial admission and experienced a mean of 2.10 readmissions for any reason during the follow-up period. 64.4% of patients underwent surveillance direct laryngoscopy and bronchoscopy during the follow-up period and suprastomal granuloma formation was detected in 31.2% of these patients. 9 patients underwent decannulation at a median of 2 years from original tracheostomy placement.

CONCLUSION

Pediatric patients under the age of 2 undergoing tracheostomy exhibit high morbidity during both the initial hospital admission and the subsequent months following discharge. However, major complications were low and mortality was not directly related to tracheostomy status in any case.