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Tracheal surgery for airway anomalies associated with increased mortality in pediatric patients undergoing heart surgery: Society of Thoracic Surgeons Database analysis

Published:November 26, 2020DOI:https://doi.org/10.1016/j.jtcvs.2020.10.149

      Abstract

      Objectives

      Airway anomalies are common in children with cardiac disease but with an unquantified impact on outcomes. We sought to define the association between airway anomalies and tracheal surgery with cardiac surgery outcomes using the Society of Thoracic Surgery Congenital Heart Surgery Database.

      Methods

      Index cardiac operations in children aged less than 18 years (January 2010 to September 2018) were identified from the Society of Thoracic Surgery Congenital Heart Surgery Database. Patients were divided on the basis of reported diagnosis of an airway anomaly and subdivided on the basis of tracheal lesion and tracheal surgery. Multivariable analysis evaluated associations between airway disease and outcomes controlling for covariates from the Society of Thoracic Surgery Congenital Heart Surgery Database Mortality Risk Model.

      Results

      Of 198,674 index cardiovascular operations, 6861 (3.4%) were performed in patients with airway anomalies, including 428 patients (0.2%) who also underwent tracheal operations during the same hospitalization. Patients with airway anomalies underwent more complex cardiac operations (45% vs 36% Society of Thoracic Surgeons/European Association for Cardiothoracic Surgery Congenital Heart Surgery Mortality category ≥3 procedures) and had a higher prevalence of preoperative risk factors (73% vs 39%; both P < .001). In multivariable analysis, patients with airway anomalies had increased odds of major morbidity and tracheostomy (P < .001). Operative mortality was also increased in patients with airway anomalies, except those with malacia. Tracheal surgery within the same hospitalization increased the odds of operative mortality (adjusted odds ratio, 3.9; P < .0001), major morbidity (adjusted odds ratio, 3.7; P < .0001), and tracheostomy (adjusted odds ratio, 16.7; P < .0001).

      Conclusions

      Patients undergoing cardiac surgery and tracheal surgery are at significantly higher risk of morbidity and mortality than patients receiving cardiac surgery alone. Most of those with unoperated airway anomalies have higher morbidity and mortality, which makes it an important preoperative consideration.

      Graphical abstract

      Key Words

      Abbreviations and Acronyms:

      aOR (adjusted odds ratio), CHD (congenital heart disease), CI (confidence interval), STAT (Society of Thoracic/European Association for Congenital Heart Surgery Mortality), STS-CHSD (Society of Thoracic Surgeons Congenital Heart Surgery Database)
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      Linked Article

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        The Journal of Thoracic and Cardiovascular SurgeryVol. 161Issue 3
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          The negative relationship of congenital heart disease with airway anomalies has long been appreciated by health care providers. Recent studies have shown that both morbidity and mortality in children undergoing repair of congenital heart disease are significantly greater in those with airway anomalies.1,2 However, the wide spectrum of pathology within each group does not permit a simple generalization of this relationship. In this study, Riggs and colleagues3 have sought to define this association in a more refined way using the Society of Thoracic Surgeons Congenital Heart Surgery Database.
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          Congenital heart defects (CHDs) and airway anomalies often occur as comorbid conditions. Although intuitively one would assume the presence of an airway anomaly would result in increased mortality, the precise impact has not been defined. In addition, when both anomalies require surgical correction, some advocate for a simultaneous approach, whereas others favor a staged approach.1,2 Lastly, the natural remaining follow-up question remains: which should be repaired first?
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      • Commentary: Congenital heart disease patients with airway anomalies do worse: We knew that, or so we thought
        The Journal of Thoracic and Cardiovascular SurgeryVol. 161Issue 3
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          In their article in this issue of the Journal, Riggs and colleagues1 use data from the Society of Thoracic Surgery Congenital Heart Surgery Database (STS-CHD) to investigate the impact of airway anomalies and tracheal surgery on the outcomes of children undergoing congenital heart surgery. Although the presence of concomitant airway anomalies in children with congenital heart disease is well known,2 there are little available data to quantify the associated risks. The authors should be congratulated, as this manuscript will be an important resource for preoperative counseling and provides a necessary framework for future studies.
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