Objectives
Measure the quality of life among families with children with tracheostomies.
Methods
We performed a prospective cross‐sectional analysis of families with children with tracheostomies ...utilizing the PedQL Family Impact Module—a validated quality of life assessment. We determined if scores were impacted by demographics using regression analysis. We also compared the tracheostomy sample's scores to a previously published cohort of children with severe cerebral palsy and birth defects that required home nursing or nursing home placement using the student's t‐test. We determined the effect size of the difference between the two groups using the Cohen's d test.
Results
Ninety‐eight families are included in the study. The average (SD) age of tracheostomy placement was 1.6 (3.5) years. The population was 60% (59/98) male and 39% (38/98) Hispanic. The principal reason for tracheostomy was due to respiratory failure (76 out of 98; 78%). The mean (SD) total Family Impact score was 76 (19). The lowest domain score was daily activity problems, mean (SD) = 67 (30) followed by worry (mean = 69, SD = 24). The lowest question score was, “I worry about my child's future,” mean (SD) = 52 (37). When compared to the comparison group of medically fragile children, the scores were statistically similar except for communication totals where tracheostomy patients reported superior scores (78.3 vs. 62.9, 95% CI, −26 to −4.8, P = .005, Cohen's d = −0.66).
Conclusion
The presence of a tracheostomy is associated with QOL scores like other medically fragile children.
Level of Evidence
4 Laryngoscope, 131:911–915, 2021
Eschew vague statements about data collection or analysis techniques. Contrast this with a more detailed account: “This study, approved by the University's IRB (#IRB number), was a retrospective ...chart review of tracheostomy patients ages 18–99 years old. ...if you are utilizing survival analysis, the book's recommendations can make your narrative clear and concise.
Objectives
To determine the demographics and treatment outcomes of patients with a peritonsillar abscess (PTA) and to provide guidance for treatment options.
Methods
The 2012 National Emergency ...Department Database, 2012 National Inpatient Sample, and 2013 Nationwide Readmissions Database were used to analyze patients with a PTA who presented to emergency departments (ED), were admitted and/or readmitted to hospitals in the United States. Outcomes were used to create a decision model to compare initial medical versus surgical management.
Results
An estimated 62,787 ED visits; 15,095 inpatient admissions; and 267 readmissions for PTA were recorded. The average age was 29 years old, with a slight male predominance. The majority of patients seen in the ED (80%) were treated without surgery and discharged home. Patients admitted to hospital were more likely to undergo surgery (50%). The tonsillectomy rate was 11%. The complication and readmission rates were < 2%. Medical therapy was used more often than surgical therapy in many cases.
Conclusion
Peritonsillar abscess mostly occurs in adults and leads to a significant number of ED visits, admissions, and readmissions. A trial of medical management of PTA appears to be safe, although surgery is highly successful and associated with low morbidity.
Level of Evidence
2c. Laryngoscope, 127:S1–S9, 2017
Objectives
Tracheal stenosis is a recognized complication of tracheostomy. Yet, the incidence and demographics of tracheal stenosis due to tracheostomies have infrequently been studied.
Methods
We ...performed a cross‐sectional analysis of U.S. emergency department (ED) visits, hospital discharges, and readmissions using the 2013 National Emergency Department Sample, 2013 National Inpatient Sample, and 2013 Nationwide Readmission Database for patients with tracheal stenosis due to tracheostomies. Also, we queried the readmission database for new tracheostomy patients who were readmitted within the same calendar year with tracheal stenosis due to the tracheostomy tube.
Results
There were an estimated 6,156 ED visits; 4,920 hospital discharges; and 2,316 readmissions for tracheal stenosis due to tracheostomies in 2013. These cases represented 28% of all tracheostomy‐related complications. Of the 103,484 patients who underwent tracheostomy in 2013, 739 (1.05%) patients were readmitted within the calendar year with tracheal stenosis due to the tracheostomy tube. These stenosis patients’ average age was 55 years old. Forty‐five percent of the patients were female and 60% were white. The mortality rate was 7.9%. The demographic risk of stenosis mirrored the risk of tracheostomy: increasing age, male gender, and black ethnicity.
Conclusion
Tracheal stenosis due to tracheostomy was uncommon, accounting for 1% of readmissions after tracheostomies, although it represented 28% of tracheostomy‐related complications and had a high mortality rate. The risk of stenosis reflected the overall tracheostomy population without apparent age, gender, or racial predilections.
Level of Evidence
NA
Laryngoscope, 129:1623–1626, 2019
Objectives/Hypothesis
To estimate the incidence of laryngotracheal stenosis among adults after intubation.
Study Design
Cross‐sectional analysis.
Methods
We used the Nationwide Readmission Database ...to examine adult patients readmitted within 45 days after admission for mechanical ventilation. Those with a diagnosis of laryngotracheal stenosis or tracheostomy dependence on their index admission were excluded. Patient demographics, associated comorbidities, and intubation lengths were compared among those with and without a diagnosis of airway stenosis at readmission.
Results
An estimated 624,918 patients met inclusion with a mean age of 59 years (standard error = 0.2). There were 1,230 patients readmitted within 45 days and diagnosed with laryngeal (N = 362) or tracheal stenosis (N = 920) estimating an incidence of 1.98 per 1,000 discharges. Compared with those without a diagnosis of airway stenosis, those with stenosis were younger (57 vs. 59 years, P < .001), more often female (62% vs. 45%, P < .001) and frequently intubated for >96 hours (47% vs. 32%, P < .001). Additionally, a history of respiratory failure, pneumonia, obesity, gastroesophageal reflux disease, and chronic steroid use were also more common among patients with stenosis. Multiple logistic regression analysis identified a decreased risk of stenosis with advancing age while an increased risk was associated strongest for females (odds ratio OR: 1.96, 95% confidence interval CI: 1.58–2.44, P < .001) and those with chronic steroid use (OR: 2.69, 95% CI: 1.80–4.02, P < .001).
Conclusion
The incidence of laryngotracheal stenosis after intubation in adults is rare but is associated with female gender and younger age.
Level of Evidence
NA Laryngoscope, 132:1723–1728, 2022
Objectives/Hypothesis
To identify risk factors for postoperative respiratory events in pediatric patients with severe obstructive sleep apnea (OSA).
Methods
Retrospective single‐institution ...retrospective cohort study of pediatric patients with severe OSA who were admitted postoperatively after tonsillectomy. Patients who experienced respiratory events after surgery were identified and differences between the respiratory event and no event groups were compared.
Results
There were 887 patients included in this study. 14.8% (n = 131) experienced a documented respiratory event. The following risk factors were found to be most significant: %sleep time with O2 < 90% (tb90) (95% CI = 1.07–1.14, OR = 1.10, p < 0.001), Black race (95% CI = 1.53–3.58, OR = 2.34, p < 0.001), primary neurologic co‐morbidity (1.67–6.32, OR = 3.27, p < 0.001), Down syndrome (1.25–5.94, OR = 2.72, p = 0.01), and age (0.84–0.94, OR = 0.88, p < 0.001). Regression modeling demonstrated that the rate of respiratory events increased with tb90.
Conclusions
Our results demonstrate that there are other potential risk factors outside of AHI and O2 nadir that are associated with respiratory events after tonsillectomy. Black race and prolonged desaturations during polysomnography (PSG) are independent risk factors. Measures of abnormal gas exchange on PSG may be better at identifying at risk patients.
Level of Evidence
4 Laryngoscope, 133:1251–1256, 2023
This is a retrospective single‐institution cohort study of pediatric patients with severe obstructive sleep apnea who were admitted postoperative after tonsillectomy. We identified multiple potential risk factors for postoperative respiratory events including Black ethnicity, Down syndrome, age, %sleep time with SpO2 <90% on sleep study.
Objectives/Hypothesis
To estimate the number, demographics, and outcomes of pediatric patients who underwent tracheostomy in 2012 and to contrast those outcomes by age, race, and gender.
Study Design
...Cross‐sectional study.
Methods
The 2012 Kids Inpatient Database was queried to identify tracheostomy patients using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) procedural codes 311, 3121, and 3129. All patients ≤18 years of age at the time of admission were included and categorized as neonates (≤28 days), infants (>28 days ≤1 year), toddler (1 to 3 years), children (4 to 12 years), adolescents (13 to 17 years), and adults (=18 years). We recorded age, gender, race, insurance status, and zip code of primary residence. We used these variables to contrast the following outcomes: length of stay, total charges, complications of care, and mortality using multiple regression analysis.
Results
An estimated 4,424 pediatric tracheostomies occurred during 2012. Fifty‐one percent of the patients were ≤3 years old, and 62% were male. Forty‐eight percentwere white followed by black (21%), Hispanic (20%), and Asian (3%). The median length of stay was 42 days, and the median total charges were $472,738. The complication rate was 29% and the mortality rate was 8.0%. The length of stay and total charges was predicted by age, with neonates having significantly longer hospitalizations. The complication rate was not associated with age, gender, or ethnicity. However, the mortality rate was associated with younger age.
Conclusions
Pediatric tracheostomies are associated with significant hospital utilizations, complications, and mortality. Increased risk of mortality is observed among neonates and infants. Continued study of tracheostomy outcomes among these subsets of the pediatric population are warranted.
Level of Evidence
4
Laryngoscope, 129:1706–1711, 2019
BACKGROUNDThe American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS-NSQIP-P) database monitors quality outcomes in pediatric surgery. However, the registry might ...underreport low-volume procedures. This review describes complications after laryngotracheal reconstruction (LTR) based on ACS-NSQIP-P reporting standards. METHODSA case series with chart review at a tertiary children's hospital included consecutive LTR procedures between 2010 and 2018. Surgical procedures were grouped into single- or double-stage for comparison of thirty-day complication rates. RESULTSEighty-four procedures were reviewed with 70% (59/84) double-stage and 30% (25/84) single-stage. Children requiring double-stage procedures were younger (3.3 vs. 6.0 years, P = .002) and more often Black or African American (51% vs. 24%, P = .03). Double-stage LTR was frequently performed on children with grade 3 or 4 subglottic stenosis (90% vs. 52%, P < 001), with a tracheostomy (97% vs. 68%, P = .001) and with gastroesophageal reflux disease (93% vs. 67%, P = .004). Airway-related complications occurred in 19% (16/84) of children and non-airway complications occurred in 16% (13/84) with similar rates between groups. Unplanned reintubation (20% vs. 0%, P = .002), ventilator support longer than 48 hours (12% vs. 0%, P = .02), and total hospitalization lengths (15.6 vs. 6.5 days, P < .001) were increased after single-stage LTR. Children with non-airway complications had more central nervous system disorders (46% vs. 10%, P = .004). CONCLUSIONPostoperative complications after pediatric LTR occur in nearly 20% of children and single-stage procedures have higher unplanned reintubations, prolonged ventilator support and hospitalization lengths. Surgeons should recognize that these typically minor events should be consistently monitored and reported after surgical expansion of the pediatric airway. LEVEL OF EVIDENCEIV.
Objective
To study a cohort of children referred for full‐night polysomnography (PSG) due to suspicion of obstructive sleep apnea (OSA). We examined the relationship between asthma, obesity, and ...severe OSA (sOSA).
Methods
We performed a retrospective case control analysis of children, ages 9 to 17 years, who underwent full‐night PSG. The primary goal was to determine the association between asthma, obesity, and sOSA (apnea‐hypopnea index ≥10). We used multiple logistic regression analysis to estimate these associations after controlling for covariates. A P value of ≤.05 was considered significant.
Results
The study included 367 children (mean standard deviation age 14 years (1.7), 56% male, 43% Hispanic). The prevalence of asthma was 188 of 367 (52%); obesity was 197 of 367 (54%); and sOSA was 109 of 367 (30%). sOSA was less likely in asthmatics (coefficient = −0.59; standard error SE = 0.23; P = .01; odds ratio OR = 0.55; 95% confidence interval CI = 0.34 to 0.88) and more likely with obesity (coefficient = 0.89; SE = 0.24; P < .001; OR = 2.4; 95% CI = 1.5 to 3.9). The presence of asthma reduced the likelihood of sOSA by an average of 14% among obese patients and 9% among nonobese patients. These associations held even after controlling for age, sex, race, income, and tonsillar hypertrophy.
Conclusion
The presence of asthma reduced, whereas obesity increased the likelihood of sOSA among a large cohort of older children referred for PSG. These relationships were additive. Further research is indicated regarding these relationships.
Level of Evidence
3b
Laryngoscope, 130:812–817, 2020
Objectives
We aimed to study laryngeal stenosis among hospitalized children in the United States from 2003–2012. We hypothesized that the prevalence of laryngeal stenosis differs by race even when ...controlling for age, gender, and commonly associated disease conditions.
Methods
We report the results of a cross‐sectional survey of hospitalized patients with laryngeal stenosis. We utilized the Kids Inpatient Database (KID) to estimate the odds of laryngeal stenosis as a function of race using regression analysis. The effects of age, gender, and commonly associated conditions were controlled.
Results
There were 13,910 estimated discharges of patients with laryngeal stenosis (95% CI 13,715–14,105) within the study period. This accounts for 55 cases of laryngeal stenosis per 100,000 discharges (overall prevalence = 0.22%). After controlling for age and gender, Black children had the highest likelihood of laryngeal stenosis with OR of 1.9 (95% CI 1.8–2.0, P < .001) along with children classified as Other (OR = 1.2, 95% CI 1.0–1.3, P = .03). White (OR = 0.89, 95% CI 0.83–0.89, P < .001), Hispanic (OR = 0.86, 95% CI 0.80– 0.92, P < .001), and Asian (OR = 0.53, 95% CI 0.43–0.64, P < .001) children were less likely to be diagnosed with laryngeal stenosis while Native Americans (OR = 0.96, 95% CI 0.63–1.45, P = .51) were equally likely.
Conclusions
Laryngeal stenosis is more common among hospitalized Black children, while other racial groups appear to have lower risk. This elevated risk remained when controlling for age, gender, and commonly associated conditions with laryngeal stenosis.
Level of Evidence
4
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