Perioperative Characteristics and Outcomes of Home-Ventilated Children Undergoing Non-Cardiac Surgery in the Pediatric NSQIP Database.

Background

Due to advancements in medicine and technology, there is a growing population of children with chronic respiratory failure that requires long-term mechanical ventilation (LTV). These patients commonly have a high degree of medical complexity and often require surgical intervention.

Aims

This study seeks to describe the perioperative characteristics, surgical interventions, and postoperative outcomes for pediatric patients with long-term ventilation (LTV)-dependence via tracheostomy undergoing elective non-cardiac surgery.

Methods

A retrospective cohort analysis was performed using the Pediatric National Surgical Quality Improvement Program (NSQIP) database from 2019 to 2023. Pediatric patients with LTV undergoing elective non-cardiac surgeries were identified. Demographic data, medical comorbidities, surgical characteristics, and postoperative outcomes were analyzed.

Results

We identified 1291 pediatric patients with home tracheostomy and ventilation requirements undergoing elective non-cardiac surgery. There were no reported intraoperative cardiac arrests or unplanned loss of secure airway amongst all patients for the years this data was available (2019-2023). There were major postoperative adverse events in five patients (0.4%) who experienced cardiac arrest requiring CPR and three patients (0.2%) who experienced 30-day mortality. There was an overall rate of 12% (n = 153) for 30-day readmission, of which 81% (n = 124) were unplanned.

Conclusions

Although children dependent on LTV have high medical complexity, serious postoperative adverse events are rare following elective surgery.