490 - Age of Tracheostomy Placement in Children and Young Adults with Severe Neurological Impairment

Publication Number: 490.3711

Osamu M. Momo, Kyoto University, Kyoto, Kyoto, Japan; Susumu Kunisawa, Kyoto University, Kyoto, Kyoto, Japan; Yoko Kawasaki, Kobe Medical and Welfare center Hidamari, Kobe, Hyogo, Japan; Daisuke Takada, Kyoto university, Kyoto, Kyoto, Japan; Kiyohide Fushimi, Institute of Science Tokyo, Tokyo, Tokyo, Japan; Yuichi Imanaka, Centre for Health Security, Kyoto University, Kyoto City, Kyoto, Japan

Background: Children with severe neurological impairments (SNI) are now surviving well into adulthood. Accordingly, health care transition (HCT) planning to adult care is becoming an important topic. Because tracheostomy is typically considered a final option with great impacts on both patients with SNI and their families, understanding the features of tracheostomy placement is crucial for HCT planning.

Objective: To determine the age distribution and characteristics of children and young adults with SNI who underwent tracheostomy.

Design/Methods: This retrospective cross-sectional study analyzed data from a nationwide inpatient database in Japan. We included patients with SNI, aged 0–39 years, who were discharged between April 2014 and March 2023 after undergoing tracheostomy placement. Patients with SNI were identified using International Classification of Diseases, 10th Revision (ICD-10) codes. To avoid including patients who had undergone tracheostomy for acute diseases, we limited the codes to those indicating chronic conditions. We did not include procedures performed during hospitalizations that recorded codes for acute injury. We classified underlying conditions using disease by the three-digit classification of ICD-10 codes and examined age-at-operation distributions for the 10 most common conditions. Additionally, we estimated age-specific in-hospital mortality rates using a generalized additive model with a binomial distribution.

Results: A total of 2,441 patients from 441 hospitals were analyzed. Cerebral palsy (CP) was the most common underlying disease, affecting 469 patients, followed by primary disorders of muscles (PDM; including muscular dystrophy, myopathy, and myotonic dystrophy) in 323 patients. Surgeries performed at 0 years of age accounted for one-third of cases, although the age distribution varied widely across different underlying diseases. For CP and PDM, age distributions showed bimodal peaks at 0 years and in the early 20s.
The estimated overall in-hospital mortality rate by age was bimodal, with peaks at 0 years (9.8% [95% CI: 7.9–12.0%]) and 25 years (9.4% [95% CI: 7.1–12.4%]). Among patients with CP and PDM, the estimated in-hospital mortality rates were highest at ages 20 years (11.3% [95% CI: 5.7–21.4%]) and 29 years (14.2% [95% CI: 8.9–21.8%]), respectively.

Conclusion(s): Patients in their 20s with SNI, particularly those with cerebral palsy or primary muscle disorders, might face increased respiratory exacerbation involving tracheostomy. Health care transition needs to be planned carefully in these patients.

Age distribution of patients who had undergone tracheostomy placement


Overall in-hospital mortality rate in hospitalizations with tracheostomy placement by age


In-hospital mortality rate of patients with cerebral palcy and primary disorders of muscles in hospitalizations with tracheostomy placement by age