Tracheostomy Related Adverse Events: Is There a Weight-Related Association in Pediatric Patients

Adults have an increased risk of tracheostomy complications as body mass increases. A similar association has not been established in pediatric patients. This study assesses the relationship between weight-for-length percentile or body mass index (BMI) and adverse tracheostomy events in infants and children, respectively.

Global Tracheostomy Collaborative database was reviewed for patients < 20 years who underwent tracheostomy (2008-2023) at a tertiary center. Data collected included age, weight, height, comorbidities, tracheostomy indication, and adverse tracheostomy events. Weight-for-length percentile for patients < 2 years and BMI percentiles for patients ≥ 2 years were calculated. Logistic regression models assessed the association of weight-for-length/BMI percentiles, demographics, and comorbidities with adverse events.

Of 474 patients (mean [SD] age, 4.1 [5.8] years), 96 (20.2%) had at least one tracheostomy adverse event. Complications included skin-related issues 19 (19.8%), tracheostomy bleeding 17 (17.7%), suprastomal granulation tissue 17 (17.7%), accidental decannulation 14 (14.6%), and tracheostomy tube obstruction 12 (12.5%). No significant association between adverse events was identified for high versus healthy weight-for-length percentiles [OR = 1.22, 95% CI: 0.59, 2.53, p-value = 0.60], nor for high versus healthy BMI percentiles [OR = 1.43, 95% CI: 0.60, 3.37, p-value = 0.42]. Despite the lack of statistical significance, the adjusted odds ratio suggested a 22% increase in odds of adverse event from healthy to high weight-for-length classification in children under 2 years [OR = 1.22], and a 43% increased odds of adverse event from healthy to high BMI percentile for children over 2 years [OR = 1.43].

Neither higher weight-for-length percentiles in infants nor increased BMI in children demonstrated a statistically significant increase of tracheostomy adverse events. The comparatively higher percentages of adverse events observed in overweight/obese children do, however, raise clinical concern and would benefit from additional larger-scale investigations.