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Considering a Weight Criterion for Neonatal Tracheostomy: An Analysis of the ACS NSQIP ‐ P
Author(s) -
Rawal Rounak B.,
Farquhar Douglas R.,
Kilpatrick Lauren A.,
Drake Amelia F.,
Zdanski Carlton J.
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27272
Subject(s) - medicine , odds ratio , complication , confidence interval , retrospective cohort study , mortality rate , surgery
Objectives Neonates weighing < 2.5 kg have known higher rates of surgical mortality and morbidity, but this remains unexamined specifically for tracheostomy. We present outcomes of neonates undergoing tracheostomy stratified by weight. Methods Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program–Pediatric from 2012 to 2014. Patients undergoing tracheostomy were included. Thirty‐day mortality and major/minor complication rates were stratified by weight (group 1: < 2.5 kg; group 2: ≥ 2.5 kg and < 4 kg; group 3: ≥ 4 kg). Patient comorbidities were assessed for independent risk factors of morbidity and mortality. Results Of 183,233 patients, 543 underwent tracheostomy. Forty‐four patients were group 1 (mean: 2.2 kg ± 0.25); 170 patients were group 2 (mean: 3.31 kg ± 0.42); and 329 patients were group 3 (mean: 6.4 kg ± 2.7). Between groups 1 and 2, there were no significant differences in mortality ( P = 0.47), major complication rates ( P = 0.99), or minor complication rates ( P = 0.64). In comparing all three groups, there were no significant differences in mortality ( P = 0.47), major complication rates ( P = 0.80), or minor complication rates ( P = 0.77). The overall 30‐day mortality for all patients was 4.24%. In a multivariate logistical regression model, weight group did not change the odds of all negative outcomes (group 1: odds ratio [OR] of 0.71; 95% confidence interval [CI], 0.33–1.53 and group 2: OR of 0.78; 95% CI, 0.50–1.22). Bronchopulmonary dysplasia was the only independent significant predictor of major complications (OR, 1.69; 95% CI, 1.02–2.79) ( P = 0.04). Conclusion Our data indicate that 30‐day mortality and morbidity outcomes for neonatal tracheostomy are not affected by weight. Overall 30‐day mortality should be discussed with caregivers preoperatively. Level of Evidence 4 Laryngoscope , 129:500–505, 2019