Prevalence, Associations, and Outcomes of Suprastomal Collapse After Pediatric Tracheostomy

Suprastomal collapse is an understudied sequela of pediatric tracheostomy that may hinder decannulation. This study aims to investigate the prevalence and associated risk factors of suprastomal collapse following pediatric tracheostomy.

A retrospective cohort study of children who underwent tracheostomy at a tertiary-care children's hospital between 1/2012 and 12/2022.

A total of 255 children underwent tracheostomy, with 146 (57.3%) developing suprastomal collapse 10.7 ± 12.6 months after the tracheostomy. Patients younger than 6 months at the time of tracheostomy were twice as likely to develop suprastomal collapse (OR = 2.07, p = 0.0059). Direct laryngoscopy and bronchoscopy findings associated with increased odds of collapse included tracheobronchomalacia (OR = 1.72, p = 0.029), subglottic stenosis (OR = 2.96, p = 0.000028), and glottic or subglottic edema (OR = 2.4, p = 0.0012). The presence of peristomal granulation tissue and the surgical removal of this tissue were not significantly associated with the development of suprastomal collapse. On log-rank analysis, the median time to develop collapse was significantly longer in patients who underwent granulation tissue removal compared to those who did not (8.2 vs. 4.8 months, p = 0.003). Patients with suprastomal collapse were significantly more likely to require upper airway surgery (OR 2.1, 95% CI 1.16-3.83, p = 0.0125) or laryngotracheal reconstruction (OR 3.4, 95% CI 1.41-9.64, p = 0.006) than those without collapse.

Suprastomal collapse occurred in 60% of our cohort and was associated with the need for airway reconstruction. Contributing factors included age at tracheostomy, tracheobronchomalacia, subglottic stenosis, and glottic and subglottic edema. Despite concerns about weakening tracheal cartilage, granulation tissue removal was not associated with the development of collapse.

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