Perioperative management and outcomes for home-ventilated children undergoing surgery

Introduction: Advances in medicine and technology have led to increased survival of children with home ventilation-dependence and chronic respiratory failure (CRF). These patients often have underlying conditions or cumulative morbidities that require surgery. There are currently no studies on the perioperative care of these patients. Methods: We conducted a retrospective cohort study of patients who underwent non-cardiac surgery at Boston Children’s Hospital from January 1, 2013 to December 31, 2019. Inclusion criteria were: (1) Diagnosis of CRF based on ICD-9/ICD-10 codes, (2) Use of home ventilation at the time of procedure. Fisher exact and Wilcoxon rank sum tests were used to examine associations between the type of respiratory support and perioperative outcomes. Results: We identified 416 patients who underwent 1623 surgeries. 56% (n = 235) were male, 59% (n = 245) had an underlying neuromuscular/neurologic condition, 20% (n = 84) had chronic lung disease, and 18% (n = 74) had congenital anomalies. At the time of surgery, 51% (n = 820) required trach-vent and 49% (n = 803) were on BiPAP. BiPAP-dependent patients were more likely to be only nocturnally vented (95% vs 45%, p < 0.001), older (median age 10.8 vs 5.5 years, p < 0.001), and less complex according to ASA status. General anesthesia was used in 93% (n = 1509) cases. Post-operatively, trach-vented patients were more likely to be admitted to the ICU (n = 627, 76%) compared to those BPAP-dependent (n = 405, 50% **stats?) and had longer ICU length of stay (median 5 vs 2 days, p < 0.001). 30-day mortality was < 1% (n = 6). 30-day readmission rate was 12%, higher in trach-vented patients (n = 122 vs n = 71, p = < 0.001). Conclusions: Home-ventilated patients presenting to surgery who are trach-vented represent a different population from those who are BPAP-dependent. Patients who require trans-tracheal ventilation appear to be more complex and it is unsurprising that they are more likely to be admitted to the ICU following surgery with a longer ICU stay. While overall mortality for these patients is quite low, reasons for frequent readmission require further study to align actual needs and services to optimize resource utilization and outcomes.