National Experience With Tracheostomy in Neonates Undergoing Congenital Heart Surgery: A Multicenter Analysis

OBJECTIVES: Our aim was to describe trends in tracheostomy utilization in infants requiring congenital heart surgery (CHS) during their index admission with specific focus on clinical and financial outcomes. DESIGN: A retrospective cohort study. SETTING: Data were obtained from the Pediatric Health Information System database. PATIENTS: Patients admitted as neonates (≤ 28 d) undergoing CHS with the use of cardiopulmonary bypass (CPB) during admission from 2004 to 2022 were identified. The cohort was divided into patients with vs. without tracheostomy. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified 13, 415 neonatal admissions who underwent CHS with use of CPB, of which 391 (3%) underwent tracheostomy. Tracheostomy patients, compared with those without, were more likely to be female (46. 8% vs. 40. 0%; p = 0. 007), of Black race (17. 1% vs. 10. 6%), preterm (29. 2% vs. 14. 1%), low birthweight (29. 4% vs. 14. 1%), had a higher frequency of chromosomal defects (23. 5% vs. 8%), congenital airway (24% vs. 3. 3%), and pulmonary (19. 7% vs. 1. 7%) abnormalities (all p < 0. 001). Tracheostomy was associated with higher in-hospital mortality (23. 8% vs. 8. 6%), longer length of stay (183 vs. 26 d), higher cost of hospitalization (1. 2 vs. 0. 2 million), and discharge to a location other than home (35. 1% vs. 6. 3%; all p < 0. 001). Tracheostomy rates increased from 1. 9% in 2004–2010 to 3% in 2017–2022 (p = 0. 002), while the in-hospital mortality in these patients was similar (p = 0. 72). CONCLUSIONS: The rate of tracheostomy placement in complex neonates and infants requiring CHS has increased in recent years. Patients with congenital airway or pulmonary abnormalities, cleft lip and/or palate, chromosomal disorders, and those requiring more than one surgery requiring CPB during admission were at greatest risk for tracheostomy placement. Tracheostomy is associated with longer ICU and hospital length of stay, six-fold increase in hospitalization cost, and higher rate of in-hospital mortality in our study population.