Incidence of Persistent Tracheocutaneous Fistula After Pediatric Tracheostomy Decannulation

Taylor B. Teplitzky, Yann-Fuu Kou, Dylan R. Beams, Romaine F Johnson, Stephen R. Chorney

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To determine the incidence of tracheocutaneous fistula (TCF) and identify characteristics associated with persistence. Study Design: Prospective cohort. Methods: All successfully decannulated children (<18 years) between 2014 and 2020 at a tertiary children's hospital were included. Revision tracheostomies, concomitant major neck surgery, or single-stage laryngotracheal reconstructions were excluded. A persistent TCF was defined as a patent fistula at 6 weeks after decannulation. Results: A total of 77 children met inclusion criteria with a persistent TCF incidence of 65% (50/77). Children with a persistent TCF were younger at placement (1.4 years (SD: 3.3) vs. 8.5 years (SD: 6.5), p < 0.001) and tracheostomy-dependent longer (2.8 years (SD: 1.3) vs. 0.9 years (SD: 0.7), p < 0.001). On univariate analysis, placement under 12 months of age (86% vs. 26% p < 0.001), duration of tracheostomy more than 2 years (76% vs. 11% p < 0.001), short gestation (64% vs. 26%, p = 0.002), congenital malformations (64% vs. 33%, p = 0.02), newborn complications (58% vs. 26%, p = 0.009), maternal complications (40% vs. 11%, p = 0.009) and chronic respiratory failure (72% vs. 41%, p = 0.01) were associated with persistent TCF. Logistic regression analysis associated duration of tracheostomy (OR: 0.14, 95% CI: 0.05–0.35, p < 0.001) and congenital malformations (OR: 0.25, 95% CI: 0.06–0.99, p = 0.049) with failure to spontaneously close. Conclusions: Two-thirds of children will develop a persistent TCF after tracheostomy decannulation. Persistent TCF is correlated with a longer duration of tracheostomy and congenital malformations. Anticipation of this event in higher-risk children is necessary when caring for pediatric tracheostomy patients. Level of Evidence: 3 Laryngoscope, 2022.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StateAccepted/In press - 2022

Keywords

  • pediatric tracheostomy
  • tracheocutaneous fistula
  • tracheostomy decannulation

ASJC Scopus subject areas

  • Otorhinolaryngology

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