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Morbidity, mortality, and follow-up after pediatric tracheostomy: A national cohort study
Matej Cankar1, Miha Zabret2, Daša Gluvajić2
1Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška street 2, Ljubljana, 1000, Slovenia.
Insights
Pediatric tracheostomy is linked to frequent complications, but mortality is not tracheostomy-related. Upper airway obstruction and laryngeal stenosis increase the need for pediatric otolaryngology (ENT) follow-up visits.
Area of Science:
- Pediatric Otolaryngology
- Tracheostomy Management
- Airway Reconstruction
Background:
- Pediatric tracheostomy is a critical intervention for managing complex airway issues.
- Understanding associated complications and follow-up needs is essential for optimal patient care.
Purpose of the Study:
- To detail clinical characteristics of pediatric tracheostomy patients.
- To quantify complications and analyze mortality rates.
- To identify factors predicting increased need for otorhinolaryngology (ENT) follow-up.
Main Methods:
- Retrospective cohort study at a Slovenian tertiary referral center.
- Analysis of 43 pediatric patients (<16 years) undergoing tracheostomy (2018-2022).
- Evaluation of indications, complications, ENT visits, and mortality.
Main Results:
- Long-term ventilation was the most common indication (58.1%).
- Complications occurred in 27.9% (early) and 51.2% (late).
- Upper airway obstruction and post-intubation laryngeal stenosis independently predicted increased ENT follow-up (p<0.05).
Conclusions:
- Pediatric tracheostomy is associated with significant complication rates.
- Mortality was not directly linked to the tracheostomy itself.
- Specific indications (upper airway obstruction) and complications (laryngeal stenosis) necessitate more frequent ENT monitoring.
Objective:
To describe the clinical characteristics, quantify complications, analyze mortality, and identify the clinical factors associated with increased need for otorhinolaryngology (ENT) follow-up visits in pediatric patients with a tracheostomy.
Design:
Retrospective cohort study.
Setting:
A single tertiary referral centre performing all pediatric tracheostomies in Slovenia.
Patients:
43 patients younger than 16 years undergoing tracheostomy between January 1st, 2018, and December 31st, 2022.
Methods And Results:
Electronic medical records were analyzed for age at tracheostomy (median: 197.0 days, IQR: 78.0-1951.0), type of tracheal cannula, intubation duration prior to tracheostomy (median: 35.0 days, IQR: 13.0-68.0), tracheostomy indications, comorbidities, tracheostomy-related complications, dysphagia with aspiration, number of ENT follow-up visits (median: 13.0, IQR: 6.0-20.0), follow up duration (median: 723 days, IQR: 374.0-1479) and mortality. The most common indication for tracheostomy was long-term ventilation (25/43; 58.1%). Early complications occurred in 12/43 patients (27.9%), while late complications affected 22/43 patients (51.2%). Eight patients (18.6%) developed post-intubation laryngeal stenosis. We identified upper airway obstruction as an indication for tracheostomy (p = 0.001) and the presence of post-intubation laryngeal stenosis (p = 0.021) to be independent risk factors for increased ENT follow-up visits. Seven patients (16.3%) died; no deaths were tracheostomy-related.
Conclusions:
Pediatric tracheostomy was associated with frequent complications. Mortality was not related to the presence of tracheostomy. Children tracheostomized for upper airway obstruction, and those with post-intubation laryngeal stenosis required significantly more ENT follow-up visits.
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