Abstract
BACKGROUND: This study aimed to use the National Health Insurance Research Database in Taiwan to examine the risk factors for tracheostomy in infants with congenital heart disease (CHD) and to evaluate the associated mortality risk in those who received a tracheostomy.
METHODS: The study was conducted between 2000 and 2011 with infants assigned to either a CHD group (34,943 subjects) or an age- and sex-matched control group (136,600 subjects). We then performed descriptive, logistic regression, Kaplan-Meier, and Cox regression analyses for the investigation.
RESULTS: Infants with CHD had an increased risk of tracheostomy (adjusted hazard ratio [HR], 6.67, 95% CI 4.40–10.10). Congenital airway anomaly (adjusted odds ratio [OR], 15.25, 95% CI 10.56–22.02), neuromuscular impairment (adjusted OR 6.24, 95% CI 4.35–8.94), and time (0–3 y) after CHD diagnosis (adjusted OR 3.27, 95% CI 2.19–4.89) were most highly correlated with tracheostomy placement. The mortality risk was increased in infants with CHD and a tracheostomy even after adjusting for confounders (adjusted HR 3.88, 95% CI 2.96–5.08). Mortality risk (adjusted HR and 95% CI) increased by 2.06 (1.56–2.71), 7.19 (2.42–21.38), and 14.76 (1.46–149.69) after 0–3, 4–7, and 8–11 y of follow-up, respectively.
CONCLUSIONS: Infants with CHD had an increased risk of undergoing tracheostomy. The mortality risk is significantly increased in infants with CHD and tracheostomy, and the risk increases progressively with time. Further studies are warranted to clarify the mechanisms underlying the risks associated with tracheostomy.
- congenital heart disease
- hazard ratio
- national health insurance
- national health insurance research database
- odds ratio
- tracheostomy
Footnotes
- Correspondence: Pesus Chou DrPH, Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, No. 155, Sec. 2, Li-Nong Street, Taipei 112, Taiwan. E-mail: pschou{at}ym.edu.tw. Wen-Jue Soong MD, Department of Pediatrics, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Road, Taipei 112, Taiwan. E-mail: wjsoong{at}vghtpe.gov.tw.
Supplementary material related to this paper is available at http://www.rcjournal.com.
This study was supported by grant funding from Taipei Veterans General Hospital (V102B-047), Taiwan. The authors have disclosed no conflicts of interest.
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