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Tracheostomy Duration Is a Key Predictor of Persistent Tracheocutaneous Fistulas in Children
Patrícia S Sousa1,2,3, Gil Coutinho1,3, Pedro Alexandre1,3
1Department of Otorhinolaryngology, Unidade Local de Saúde São João, Porto, PRT.
Cureus
|March 10, 2025
Summary
Most pediatric tracheocutaneous fistulas close spontaneously after decannulation. However, prolonged tracheostomy duration, especially over 12 months, significantly increases the risk of persistent fistulas requiring surgical intervention.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Respiratory Medicine
Background:
- Persistent tracheocutaneous fistula is a complication following pediatric tracheostomy decannulation.
- Understanding risk factors is crucial for managing this sequela.
Purpose of the Study:
- To determine the frequency of persistent tracheocutaneous fistulas in pediatric patients.
- To identify risk factors associated with persistent tracheocutaneous fistulas after decannulation.
Main Methods:
- Retrospective analysis of pediatric patients undergoing tracheostomy decannulation (2008-2021).
- Comparison of spontaneous versus surgical closure of tracheocutaneous fistulas.
- Evaluation of variables including comorbidities and ventilation duration.
Main Results:
- Of 19 decannulated patients, 63.2% experienced spontaneous fistula closure, while 36.8% required surgical closure.
- Prolonged tracheostomy duration (mean 26.7 months) was significantly associated with surgical closure (p=0.022).
- Tracheostomy placement exceeding 12 months predicted the need for surgical closure (p=0.045).
Conclusions:
- Spontaneous closure is common for pediatric tracheocutaneous fistulas.
- Prolonged tracheostomy is a key predictor for persistent fistulas requiring surgical intervention.
- Duration of tracheostomy is an important factor when planning pediatric decannulation.
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