Tracheal A-frame deformity and suprastomal collapse after pediatric tracheostomy

Area of Science:

• Pediatric Otolaryngology
• Respiratory Medicine
• Surgical Outcomes

Background:

• Tracheostomy is a common procedure in children requiring prolonged airway support.
• Acquired airway stenosis, including A-frame deformity and suprastomal collapse, are known complications following pediatric tracheostomy.
• Long-term outcomes and incidence rates of these specific airway complications require further elucidation.

Purpose of the Study:

• To determine the incidence of A-frame deformity and suprastomal collapse in pediatric patients after tracheostomy.
• To identify risk factors and temporal patterns associated with the development of these post-tracheostomy airway complications.

Main Methods:

• Retrospective cohort study including pediatric patients (<18 years) who underwent tracheostomy between 2015 and 2020.
• Inclusion criteria required surveillance bronchoscopy at least 6 months post-tracheostomy.
• Operative reports were reviewed to identify A-frame deformity and suprastomal collapse.

Main Results:

• A-frame deformity developed in 18% of 175 children, with an estimated 5-year incidence of 32.8%.
• Suprastomal collapse occurred in 55% of patients, with an estimated 5-year incidence of 73.7%.
• Older age at tracheostomy was associated with a lower likelihood of collapse (OR: 0.92), while highly complex children experienced earlier A-frame development.

Conclusions:

• Tracheal A-frame deformity affects a significant proportion of children within 3 years post-decannulation.
• Suprastomal collapse is highly prevalent, approaching 74% at 5 years, and is more common in younger patients.
• Clinicians should be aware of these acquired airway obstructions and monitor pediatric tracheostomy patients accordingly.