TY - JOUR
T1 - Incidence of Persistent Tracheocutaneous Fistula After Pediatric Tracheostomy Decannulation
AU - Teplitzky, Taylor B.
AU - Kou, Yann-Fuu
AU - Beams, Dylan R.
AU - Johnson, Romaine F
AU - Chorney, Stephen R.
N1 - Funding Information:
“This project is part of the ‘Qualitätsoffensive Lehrerbildung’, a joint initiative of the Federal Government and the Länder which aims to improve the quality of teacher training. The programme is funded by the Federal Ministry of Education and Research. The authors are responsible for the content of this publication.”
Publisher Copyright:
© 2022 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2022
Y1 - 2022
N2 - 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.
AB - 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.
KW - pediatric tracheostomy
KW - tracheocutaneous fistula
KW - tracheostomy decannulation
UR - http://www.scopus.com/inward/record.url?scp=85129844631&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85129844631&partnerID=8YFLogxK
U2 - 10.1002/lary.30163
DO - 10.1002/lary.30163
M3 - Article
C2 - 35546063
AN - SCOPUS:85129844631
SN - 0023-852X
JO - Laryngoscope
JF - Laryngoscope
ER -