Pediatric Otolaryngology Fellow UT Southwestern, Children's Medical Center Dallas UT Southwestern, Children's Medical Center Dallas
Objective: Tracheocutaneous fistula (TCF) commonly persist after pediatric tracheostomy decannulation with estimations of incidence and risk factors based on retrospective series. The primary objective determined the incidence of TCF in a prospective cohort of decannulated children with secondary objectives identifying patient characteristics associated with persistence.
Method: A prospective cohort included all children ( <18 years) who underwent tracheostomy between 2014 and 2021 at a tertiary children’s hospital that were successfully decannulated. Children having revision tracheostomies, concomitant major neck surgery, or single-stage laryngotracheal reconstructions were excluded. A persistent TCF was defined as a patent fistula by 6 weeks post decannulation.
Results: A total of 77 children met inclusion with a persistent TCF incidence of 65% (50/77). Children who had a persistent TCF were younger at placement (1.4 years (SD: 3.3) vs. 8.5 years (SD: 6.5), P <.001) and were tracheostomy-dependent longer (2.8 years (SD: 1.3) vs. 0.9 years (SD: 0.7), P <.001). Gender (P=.53), race (P=.53) and ethnicity (P=.86) were no different between groups but gestational age was shorter (31.3 weeks (SD: 6.6) vs. 37.4 weeks (SD: 4.3), P <.001) for children with TCF persistence. Spontaneously closing fistulas were noticed at a mean of 2.8 months (SD: 3.9) and 42 children underwent TCF repair at a mean of 7.6 months (SD: 5.0) after decannulation. Persistent TCF was more common among children with congenital malformations (78% vs. 50%, P=.01), newborn complications (81% vs. 51%, P=.007), maternal complications (87% vs. 50%, P=.008), chronic respiratory failure (77% vs. 47%, P=.007), and were less common among children with a history of trauma (29% vs. 69%, P=.03). Logistic regression analysis associated age at tracheostomy (OR: 1.01, 95% CI: 1.00-1.02, P=.04), duration of tracheostomy (OR: 0.25, 95% CI: 0.10-0.58, P=.001), and history of congenital malformations (OR: 0.22, 95% CI: 0.05-0.95, P=.04) with TCF persistence.
Conclusion: Nearly two-thirds of children will develop a persistent TCF after tracheostomy decannulation and is strongly correlated with younger age at placement, longer duration of tracheostomy and congenital malformations. Anticipation of this event in higher-risk children is necessary when caring for pediatric tracheostomy patients.