Decreasing tracheostomy placement in hospitalized pediatric patients with subglottic stenosis - Kids' Inpatient Database (KID) analysis

Objectives: We aimed to assess procedural trends for tracheostomy placement in the management of children with subglottic stenosis. We hypothesize that with increased use of less invasive airway interventions for subglottic stenosis, tracheostomy may be performed less frequently over time.

Methods: Data were collected from the Kids' Inpatient Database (KID) for pediatric discharges with an admission diagnosis of subglottic stenosis (Stenosis of larynx: ICD-9 code 478.74) from across the United States for years 2000, 2003, 2006, 2009, and 2012. The number of overall procedures and specific airway procedures including tracheostomy (ICD-9-CM codes 31.1, 31.29) were evaluated.

Results: A weighted estimate of 18,124 pediatric discharges with a diagnosis of subglottic stenosis were identified. Overall, there was an increase in the mean number of procedures performed during hospitalization from 2000 to 2012 (p < 0.001); however, there was a decrease in the proportion of children undergoing tracheostomy placement (p < 0.001).

Conclusions: Trends over the past decade from a US national database have revealed decreasing tracheostomy placement in hospitalized pediatric patients with subglottic stenosis. This may be due to a change in paradigm with increased use of less invasive, possibly endoscopic, treatment in this patient population. Further investigations may be helpful to identify management paradigms to optimize care in order to help avoid tracheostomy placement.