Predicting postoperative tracheostomy requirement in children undergoing surgery for posterior fossa tumors

Eric A. Goethe, Melissa A. LoPresti, Nisha Gadgil, Sandi Lam*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Purpose: Posterior fossa tumor (PFT) resection can be associated with postoperative respiratory failure. We aimed to identify risk factors predicting tracheostomy dependence in children after PFT resection. Methods: Retrospective chart review of all children undergoing PFT resection from April 2007 to May 2017 at our institution was performed. Results: A total of 197 patients were included; 12 (6.1%) required tracheostomy placement at a mean 69.1 days postoperatively (SD 112.7, range 7–388). Patients requiring tracheostomy were younger (3.4 vs. 6.8 years, p < 0.01), more likely to have postoperative dysphagia (91.7% vs. 17.3%, p < 0.01), and more likely to have an ependymoma (41.7% vs. 15.1%, p < 0.01) or astrocytoma (25.0% vs. 8.1%, p < 0.01). Patients with eventual tracheostomy were less likely extubated immediately postoperatively (45.5% vs. 79.6%, p < 0.01), had longer intubation duration postoperatively (5.7 vs. 0.5 days, p < 0.01), and had higher rates of reintubation within 48 h (63.6% vs. 1.3%, p < 0.01). Patients requiring tracheostomy had longer hospital length of stay (45.8 vs. 15.3 days, p < 0.01) and ICU stay postoperatively (13.5 vs. 2.1 days, p < 0.01). Of those requiring tracheostomy, three (25.0%) were decannulated by 1 year postoperatively. Decannulation rates did not vary by age (p < 0.47), extubation failure (p < 0.24), duration of intubation (p < 0.10), tumor histology (p < 0.23), or tumor grade (p < 0.13). Conclusion: Lower cranial neuropathy following PFT resection is common. Identifying risk factors correlated with need for tracheostomy can help identify patients who may benefit from early tracheostomy, reducing prolonged intubation trauma, time on mechanical ventilation, and length of stay.

Original languageEnglish (US)
JournalChild's Nervous System
DOIs
StateAccepted/In press - Jan 1 2020

Keywords

  • Cranial neuropathy
  • Pediatric neurosurgery
  • Posterior fossa tumor
  • Respiratory failure
  • Tracheostomy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Predicting postoperative tracheostomy requirement in children undergoing surgery for posterior fossa tumors'. Together they form a unique fingerprint.

  • Cite this