Tracheostomy Duration Is a Key Predictor of Persistent Tracheocutaneous Fistulas in Children

Abstract

Introduction Pediatric tracheostomy is a surgical procedure that secures the airway in children with upper airway obstruction or those in need of pulmonary support. Persistent tracheocutaneous fistula is a potential sequela that can occur after the decannulation process. Objectives To evaluate the frequency and risk factors that lead to a persistent tracheocutaneous fistula. Material and methods This is a retrospective analysis of pediatric patients who underwent tracheostomy decannulation in a tertiary hospital from 2008 to 2021. Results Nineteen patients, ranging from 6 days to 17 years old, underwent tracheostomy and were later decannulated. Twelve cases (63.2%) closed spontaneously while 7 patients (36.8%) required surgical closure of the tracheocutaneous fistula. Variables such as neurologic comorbidities, laryngotracheomalacia, and prolonged ventilation did not show statistically significant differences between the two groups. The mean tracheostomy duration was 7.8 and 26.7 months for spontaneous and surgical closure of a tracheocutaneous fistula, respectively. Most of the spontaneous closures (83.3%) occurred after 1.5 months. When comparing surgical and spontaneous closure, those needing surgical closure had a tracheostomy for a longer time (p=0.022), especially if the tracheostomy tube was placed more than 12 months (p=0.045). Conclusion In this series, most patients had a spontaneous closure of the tracheocutaneous fistula. The main factor for a persistent tracheocutaneous fistula was prolonged tracheostomy, which may be considered an outcome predictor whenever decannulation is planned.

Keywords: pediatric tracheostomy; post tracheostomy; tracheo-cutaneous fistula; tracheostomy decannulation (td); tracheostomy timing; pediatric.