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

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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.

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Abbreviations

PFT:

Posterior fossa tumor

ATRT:

Atypical teratoid/rhabdoid tumor

JPA:

Juvenile pilocytic astrocytoma

GTR:

Gross total resection

STR:

Subtotal resection

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Authors and Affiliations

  1. Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin St, Houston, TX, 77030, USA

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

  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

    Sandi Lam

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  1. Eric A. Goethe
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  2. Melissa A. LoPresti
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  3. Nisha Gadgil
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  4. Sandi Lam
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Correspondence to Sandi Lam.

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Goethe, E.A., LoPresti, M.A., Gadgil, N. et al. Predicting postoperative tracheostomy requirement in children undergoing surgery for posterior fossa tumors. Childs Nerv Syst 36, 3013–3019 (2020). https://doi.org/10.1007/s00381-020-04605-7

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  • DOI: https://doi.org/10.1007/s00381-020-04605-7

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