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Incidence of Persistent Tracheocutaneous Fistula After Pediatric Tracheostomy Decannulation
Taylor B Teplitzky1, Yann-Fuu Kou1,2, Dylan R Beams1
1Department of Otolaryngology - Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Insights
Two-thirds of children develop a persistent tracheocutaneous fistula (TCF) after decannulation. Longer tracheostomy duration and congenital malformations are linked to TCF persistence in pediatric patients.
Area of Science:
- Pediatric Otolaryngology
- Surgical Complications
- Respiratory Management
Background:
- Tracheocutaneous fistula (TCF) is a potential complication following tracheostomy in children.
- Understanding the incidence and risk factors for persistent TCF is crucial for patient management.
Purpose of the Study:
- To determine the incidence of TCF after decannulation in children.
- To identify patient characteristics and clinical factors associated with persistent TCF.
Main Methods:
- A prospective cohort study included children (<18 years) decannulated between 2014-2020.
- Persistent TCF was defined as a fistula patent at 6 weeks post-decannulation.
- Exclusion criteria included revision tracheostomies and major neck surgeries.
Main Results:
- The incidence of persistent TCF was 65% (50/77 children).
- Younger age at tracheostomy placement and longer tracheostomy duration were associated with persistent TCF.
- Univariate analysis identified prematurity, congenital malformations, and respiratory failure as risk factors.
Conclusions:
- Persistent TCF affects approximately two-thirds of decannulated children.
- Longer tracheostomy duration and congenital malformations are significantly associated with persistent TCF.
- Proactive identification and management of high-risk children are necessary.
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, 133:417-422, 2023.
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