Tracheitis after pediatric tracheostomy: A NSQIP analysis

Tracheostomy-associated tracheitis is a common postoperative complication in children, yet its early incidence and risk factors remain poorly defined.

To identify predictors and outcomes of tracheitis within 30 days following pediatric tracheostomy.

The NSQIP-P database (2019-2023) was queried for children undergoing tracheostomy. Postoperative tracheitis within 30 days was defined by new positive tracheal cultures and antibiotic treatment. Associations with demographic and clinical variables were assessed using Poisson regression with robust variance to estimate adjusted risk ratios, with propensity score weighting and stratified analyses used to evaluate the impact of baseline illness severity.

Among 5,784 tracheostomies, 652 (11.3%) developed tracheitis at a mean of 11 ± 8 days postoperatively. Preoperative steroid use (excluding a single dose), nutritional support, cardiac comorbidities, and unplanned postoperative intubation were associated with increased risk in unadjusted analyses. Associations for steroid use, nutritional support, and cardiac comorbidities persisted in ASA-stratified analyses and exposure-specific propensity score-weighted models. Age, gestational age, ASA classification, and chronic lung disease were not independently associated. Patients with tracheitis had higher rates of pneumonia (11.5% vs 4.6%) and sepsis (20.7% vs 4.3%), as well as longer hospital stays (all p < 0.001).

Tracheitis occurred in 11% of children within 30 days of tracheostomy and was associated with increased odds of pneumonia, sepsis, and longer hospital stay. Associations with preoperative factors were partly explained by baseline illness severity but persisted within comparable severity groups. Early identification of high-risk patients may inform targeted prevention and quality improvement efforts.