Azari, Sarah

Chennupati, Sri Kiran, MD

Trexler, Debra M, RN

Weaver, Daniel

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksResearch Scholars Poster PresentationA Year in Review: A Retrospective Analysis ofTracheotomies and AdenotonsillectomiesDaniel WeaverLehigh University, Daniel.Weaver@lvhn.orgSarah AzariLehigh Valley Health Network, Sarah.Azari@lvhn.orgDebra M. Trexler RNLehigh Valley Health NetworkSri Kiran Chennupati MDLehigh Valley Health Network, sri_k.chennupati@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/research-scholars-postersThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtWeaver, D., Hoover, T., Azari, S., Trexler, D., Chennupati, S., (2017, July, 31) A Year in Review: A Retrospective Analysis of Tracheotomiesand Adenotonsillectomies. Poster presented at LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network,Allentown, PA.© 2017 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, PennsylvaniaA Year in Review: A Retrospective Analysis of Tracheotomies and AdenotonsillectomiesCreated protocol and code book for both adenotonsillectomies and tracheotomies Submitted for electronic Institutional Review Board approval for a quality improvement projectRetrospective chart review of 103 adenotonsillectomy patients using EPIC database Review of tracheotomy patient reports tracked by the National Surgical Quality Improvement Program (NSQIP)Analysis of 30 day outcomes including complication rates, efficacy, and risk factors associated with higher complication rates Daniel Weaver, Travis Hoover, Sarah Azari, Debra Trexler RN, Sri Kiran Chennupati, MD, FAAPDepartment of Pediatric Surgical SpecialtiesBACKGROUND / INTRODUCTIONMETHODSRESULTSCONCLUSIONS/FUTURE STUDIESRisk Factors LVHN DataN (%)National Data5N (%)Prematurity (birth < 37 weeksgestation) 5 (71.4) 112 (54.4)Pulmonary risk factors 7 (100.0) 203 (98.5)Gastrointestinal disease 5 (71.4) 109 (52.9)CardiacMajor 2 (28.6) 52 (25.2)Minor 1 (14.3) 76 (36.9)• Each year, over 100,000 tracheotomy procedures are performed and 38.8 percent of cases involving children under the age of 18 experience some sort of complication resulting from the procedure1,2 • In children under the age of fifteen, 530,000 tonsillectomies with or without adenoidectomies are performed each year3• With a success rate of 79 percent, tonsillectomies are used for the treatment of sleep apnea due to obstructive breathing patterns during sleep4Purpose: Our goal is to determine the complications and outcomes associated with adenotonsillectomy and tracheotomy procedures to provide safer clinical outcomes as well as transparency for the expectations of patients and their families References1. Yu, M. (2010). Tracheostomy patients on the ward: multiple benefits from a multidisciplinary team? Critical Care, 14(109). doi:10.1186/cc82182. Watters, K, O'Neill, M, Zhu, H, Graham, RJ, Hall, M, Berry, J (2017) Two-year mortality, complications, and healthcare use in children with medicaid following tracheostomy. Laryngoscope, 126(11), 2611-2617. doi: 10.1002/lary.25972.3. Reginald F. Baugh, MD, Sanford M.Archer, MD, Ron B. Mitchell, MD, Richard M. Rosenfeld, MD, MPH, Raouf Amin, MD, James J. Burns, MD… Milesh M. Patel, MS (2011). Clinical Practice Guideline: Tonsillectomy in Children. Sage Journals Vol 144, Issue 1, pp. S1 - S30.4. Yoon PJ, Scholes MA, Friedman NR. Ear, Nose, & Throat. In: Hay WW, Jr., Levin MJ, Deterding RR, Abzug MJ et al.eds. CURRENT Diagnosis & Treatment Pediatrics, 23e. New York, NY: McGraw-Hill.5. Mahida JB, Asti L, Boss EF, Shah RK, Deans KJ, Minneci PC, Jatana KR. Tracheostomy Placement in Children Younger Than 2 Years30-Day Outcomes Using the National Surgical Quality Improvement Program Pediatric. JAMA Otolaryngolgy Head Neck Surg. 2016;142(3):241-246. doi:10.1001/jamaoto.2015.33026. Francis, D. O., Fonnesbeck, C., Sathe, N., Mcpheeters, M., Krishnaswami, S., & Chinnadurai, S. (2017). Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta-analysis. Otolaryngology-Head and Neck Surgery, 156(3), 442-455. doi:10.1177/0194599816683915Figure 3. Sleep Study Improvements Table 1. Risk Factors Rates for Tracheotomy Complications Figure 1. Comparison of Tracheotomy Complications at LVHN          to National StandardFigure 2. Postoperative Adenotonsillectomy Complications• Patients diagnosed with obstructive sleep apnea had an average decrease of Apnea-Hypopnea events of 58.7% and an average increase of oxygen-saturation of 3.3% • Although the complications from tracheotomies appear much higher at LVHN compared to the national standard, our study is limited by the small amount of tracheotomies performed at LVHN • Pulmonary risk factors, prematurity, and cardiac risk factors were indicative of higher complication rates and longer hospital stays among patients with tracheotomies • Despite high rates of readmission and ED visits, patients receiving adenotonsillectomies only required reoperation in less than 1% of cases compared to the national average of 4%6• Further review will provide a better statistical representation surgical outcomes • To decrease the amount of postoperative complications, future studies regarding the implementation                           of different or additional medication may be conducted 17.488.746.935.834.850.570.002.004.006.008.0010.0012.0014.0016.0018.0020.000246810121416LVHN Data National Data20.336.1685.53%88.82%0102030405060708090100AHIPreopAHIPostopO2 SatPreopO2 SatPost* Rate calculated from all 348 patients receiving adenotonsillectomiesin the past year

A Year in Review: A Retrospective Analysis of Tracheotomies and Adenotonsillectomies

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A Year in Review: A Retrospective Analysis of Tracheotomies and Adenotonsillectomies

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