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Long-Term Outcomes After Pediatric Tracheostomy-Candidates for and Timing of Decannulation
Akinori Sekioka1, Koji Fukumoto1, Hiromu Miyake1
1Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
Insights
Pediatric tracheostomy outcomes were reviewed, finding temporary infections led to successful decannulation. Chromosome-gene disorders negatively impacted decannulation success in critically ill children.
Area of Science:
- Pediatric surgery
- Critical care medicine
- Otolaryngology
Background:
- Pediatric tracheostomy is a vital, life-saving procedure with unclear long-term outcomes.
- This study addresses long-term outcomes and decannulation factors in pediatric tracheostomy patients.
- A Japanese tertiary hospital's data from 2001-2014 was retrospectively analyzed.
Purpose of the Study:
- To review outcomes after pediatric tracheostomy.
- To identify factors influencing decannulation success and timing.
- To clarify patient candidates for successful decannulation.
Main Methods:
- Retrospective review of 184 critically ill children who underwent tracheostomy.
- Analysis of demographics, complications, and decannulation status.
- Comparison between decannulation (D group) and non-decannulation (ND group) cohorts, excluding specific patient groups.
Main Results:
- The overall mortality rate was 25%, with a successful decannulation rate of 21%.
- Temporary infections as an indication correlated with more successful and earlier decannulation (median 0.7 years).
- Chromosome-gene disorders were associated with poorer decannulation outcomes (34% vs 15% in ND vs D group).
Conclusions:
- Temporary infections facilitate successful pediatric tracheostomy decannulation.
- Chromosome-gene disorders present a significant comorbidity affecting decannulation.
- Understanding these factors can optimize pediatric tracheostomy management and decannulation strategies.
Background:
Although pediatric tracheostomy has been a widely performed, life-saving procedure, its long-term outcomes have remained unclear. This study aimed to review outcomes after tracheostomy at a Japanese tertiary hospital and clarify candidates for and timing of decannulation.
Materials And Methods:
Hospital records of critically ill children who underwent tracheostomy from 2001 to 2014 were retrospectively reviewed, subsequently analyzing outcomes according to demographics, complications, and decannulation. After excluding those who were lost to follow-up or had irreversible neuromuscular impairment, the remaining patients were divided into the decannulation (D group) and nondecannulation (ND group) groups and compared.
Results:
In total, 184 patients who underwent tracheostomy were analyzed (median age at operation: 0.5 y). The major indication for tracheostomy was irreversible neuromuscular impairment (46%). Surgery-related and overall mortality rates were 1% and 25%, respectively, while the successful decannulation rate was 21%. No significant difference in surgical indications or comorbidities was observed between the D (n = 39) and ND (n = 50) groups, except for infection (7 in D group versus 0 in ND group; P = 0.002) and chromosome-gene disorder (15% versus 34%; P = 0.04). The ND group had a significantly higher mortality rate than the D group (46% versus 3%; P < 0.0001). The median time to decannulation was 3.6 years, while that for infection was 0.7 y.
Conclusions:
Patients who underwent tracheostomy at our institution due to temporary infections achieved more successful and earlier decannulation compared to other indications. Chromosome-gene disorder as a comorbidity can negatively affect decannulation.
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