Predicting postoperative tracheostomy requirement in children undergoing surgery for posterior fossa tumors
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ORIGINAL ARTICLE
Predicting postoperative tracheostomy requirement in children undergoing surgery for posterior fossa tumors Eric A. Goethe 1 & Melissa A. LoPresti 1 & Nisha Gadgil 1 & Sandi Lam 1,2 Received: 24 March 2020 / Accepted: 30 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Posterior fossa tumor . Respiratory failure . Tracheostomy . Cranial neuropathy . Pediatric neurosurgery
Abbreviations PFT Posterior fossa tumor ATRT Atypical teratoid/rhabdoid tumor JPA Juvenile pilocytic astrocytoma GTR Gross total resection STR Subtotal resection
* Sandi Lam [email protected]; [email protected] 1
Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin St, Houston, TX 77030, USA
2
Department of Neurosurgery, Division of Pediatric Neurosurgery, Northwestern University Feinberg School of Medicine, Lurie Children’s Hospital, 225 E Chicago Ave, Chicago, IL 60611, USA
Introduction Pediatric posterior fossa tumors (PFTs) occur at an incidence of 2–3.5 per 100,000, accounting for 60–70% of all pediatric brain tumors [9, 17], and are associated with significant morbidity. Among these include lower cranial neuropathies occurring in as many as one-third of the patients [6, 18]. Roughly 5%
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