TY - JOUR
T1 - Post-ECMO chest tube placement
T2 - A propensity score-matched survival analysis
AU - Tashiro, Jun
AU - Perez, Eduardo A.
AU - Lasko, David S.
AU - Sola, Juan E.
N1 - Funding Information:
The Kid’s Inpatient Database (KID) is a sample of pediatric hospital admissions from across the United States, maintained by the Healthcare Cost and Utilization Project and sponsored by the Agency for Healthcare Research and Quality. Approximately 2 to 3 million cases of admitted patients ≤ 20 years old are captured in the KID for each release. Datasets are available triennially for years 1997, 2000, 2003, 2006, and 2009. Using the KID, investigators have conducted survival analyses in overall pediatric surgery procedures [12,13] , patent ductus arteriosus ligation [14] , esophageal atresia and tracheoesophageal fistula repair [15] , extracorporeal membrane oxygenation [16] , or congenital diaphragmatic hernia repair [17] . Cases of ECMO were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code 39.65. ECMO-associated CT placements were identified using ICD-9-CM procedure code 34.04 and defined as those occurring < 8 days after cannulation. CT placements occurring prior to ECMO or ≥ 8 days after cannulation were deemed to be unrelated to ECMO cannulation for the purposes of this study. Children undergoing ECMO cannulation at < 30 days of life were defined in a subcategory (Neonatal ECMO) for an additional analysis. Age at procedure for ECMO cannulation and CT placement was derived using the age at admission and adding the date of procedure for the admission; cost per day was calculated using total charges (TC) of the admission divided by length of stay (LOS). Continuous data with nonparametric distributions are presented as median (interquartile range; IQR). These measures were compared using t-tests or Mann-Whitney tests, whereas categorical variables were compared using chi-squared tests. Additionally, binary logistic regression model was constructed to examine the effect of CT placement on survival. Model performance is presented as area under the curve (AUC), where 0.5 is the null hypothesis and 1.0 is perfect approximation. Propensity score (PS) matching was performed using the MatchIt package 2.4-20 on R 2.14.2 (R Project for Statistical Computing; Vienna, Austria) [18] . Confounding variables included in the matching process included demographic and clinical factors, as well as hospital characteristics. Cases were weighted to project national estimates. All analyses were performed using SPSS 21.0 (IBM Corporation; Armonk, NY). The Institutional Review Board at the University of Miami (Miami, FL) deemed this retrospective study to be exempt from full review. 2
Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Background Severe morbidity and mortality has been reported from chest tube (CT) placement during pediatric extracorporeal membrane oxygenation (ECMO). Methods Kids' Inpatient Database (KID) was analyzed for ECMO with CT placed < 8 days postcannulation (1997-2009). Results Overall, 5884 patients were identified (213 CT) (56% male, 49% white), with a median (IQR) age at ECMO cannulation 7 (117) days, length of stay (LOS) 26 (35) days, and total charges (TC) 342,116 (409,573) USD. Diagnoses included congenital diaphragmatic hernia (CDH) 16%, meconium aspiration (MA) 2%, pulmonary hypertension (PH) 13%, respiratory distress syndrome (RDS) 41%, and cardiac (C) 29%. Survival was overall 57%, CDH 47%, MA 88%, PH 75%, RDS 57%, and C 52%. There were no differences in survival between CT and non-CT patients compared overall, or by diagnosis, or by age < 30 days, or by diagnosis and age < 30 days. Multivariate analysis and propensity score matching for all ages, or < 30 days of age by diagnosis showed no difference in survival between CT and non-CT patients. Conclusion Analysis of KID with correlative propensity score matching demonstrates no increased mortality in pediatric ECMO patients requiring CT placement.
AB - Background Severe morbidity and mortality has been reported from chest tube (CT) placement during pediatric extracorporeal membrane oxygenation (ECMO). Methods Kids' Inpatient Database (KID) was analyzed for ECMO with CT placed < 8 days postcannulation (1997-2009). Results Overall, 5884 patients were identified (213 CT) (56% male, 49% white), with a median (IQR) age at ECMO cannulation 7 (117) days, length of stay (LOS) 26 (35) days, and total charges (TC) 342,116 (409,573) USD. Diagnoses included congenital diaphragmatic hernia (CDH) 16%, meconium aspiration (MA) 2%, pulmonary hypertension (PH) 13%, respiratory distress syndrome (RDS) 41%, and cardiac (C) 29%. Survival was overall 57%, CDH 47%, MA 88%, PH 75%, RDS 57%, and C 52%. There were no differences in survival between CT and non-CT patients compared overall, or by diagnosis, or by age < 30 days, or by diagnosis and age < 30 days. Multivariate analysis and propensity score matching for all ages, or < 30 days of age by diagnosis showed no difference in survival between CT and non-CT patients. Conclusion Analysis of KID with correlative propensity score matching demonstrates no increased mortality in pediatric ECMO patients requiring CT placement.
KW - Chest tubes
KW - Extracorporeal membrane oxygenation
KW - Thoracostomy Outcomes research
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U2 - 10.1016/j.jpedsurg.2015.02.038
DO - 10.1016/j.jpedsurg.2015.02.038
M3 - Article
C2 - 25783367
AN - SCOPUS:84928704068
VL - 50
SP - 793
EP - 797
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 5
ER -