The impact of maturation sutures on false passage formation in pediatric tracheostomy

False passage (FP) after tracheostomy is an infrequent but potentially life-threatening complication. The practice of tracheal stomal maturation at the time of tracheostomy is variable amongst surgeons in pediatric patients, and it remains unknown whether or not maturation sutures decrease the risk of FP. Our objective was to evaluate the impact of maturation sutures on the incidence of FP after pediatric tracheostomy.

A retrospective review of children who underwent tracheostomy (2001-2024) was performed. Records were reviewed for demographics and procedural details including use of maturation sutures. Outcomes included incidence of FP, time to FP and associated complications resulting from FP.

One-hundred and twenty-five children met study criteria [median (IQR) age 0.5 (0.2-3.2) years]. Fifty-five children (44.0 %) received maturation sutures, with 31 (56.4 %) of these being four-point sutures, 10 (18.2 %) being two-point sutures (70 % of which were placed inferiorly), and 14 (25.5 %) being unrecorded. Four out of 125 (3.2 %) patients developed FP at a median (IQR) of 12.8 (4.6-13.5) days following tracheostomy insertion, and they all occurred within the first two tracheostomy changes. None of the patients who developed FP had maturation sutures. Of the four children who developed FP, three (75 %) had no further complications, and one (25 %) developed subcutaneous emphysema and pneumomediastinum. No deaths associated with FP were identified.

This large single institution study evaluating the relationship between maturation sutures and FP in children undergoing tracheostomy suggests that maturation sutures may help prevent FP; however, ongoing work is required to validate these findings and guide clinical practice.