Incidence of Persistent Tracheocutaneous Fistula After Pediatric Tracheostomy Decannulation

Teplitzky, Taylor B.; Kou, Yann‐Fuu; Beams, Dylan R; Johnson, Romaine F.; Chorney, Stephen R.

doi:10.1002/lary.30163

Cited by 6 publications

(5 citation statements)

References 32 publications

(82 reference statements)

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“…TCF is not uncommon in children. Our previous study and a recent study by Teplitzky et al report a 57%-65% rate of TCF in children following decannulation, with tracheostomy dependence over 2 years being an identified risk factor 2,7. Notably, in the Teplitzky et al article, 50 of 77 children developed a TCF and none of the patients underwent stomal maturation.…”

mentioning

confidence: 68%

Pediatric Tracheotomy Stomal Maturation and Tracheocutaneous Fistulas

Ha,

Jain,

Schuman

et al. 2024

The Laryngoscope

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ObjectiveThe purpose of this study is to determine whether tracheostomy stomal maturation affects the risk of tracheocutaneous fistula (TCF) in children.MethodsA retrospective chart review was conducted for all children who both underwent a tracheostomy and were decannulated between 2012 and 2021 at a tertiary children's hospital. Charts were analyzed for demographics, surgical technique, and development of a TCF. TCF was defined as a persistent fistula following 3 months after decannulation.Results179 children met inclusion criteria. The median (interquartile range) age at tracheostomy was 1.5 (82.4) months, average (standard deviation [SD]) duration of tracheotomy was 20.0 (20.6) months, and length of follow‐up after decannulation (range; SD) was 39.3 (4.4–110.0; 26.7) months. 107 patients (60.0%) underwent stomal maturation and 98 patients developed a TCF (54.7%).Younger age at tracheostomy placement was significantly associated with increased risk of TCF, mean (SD) age 28.4 (51.4) version 80.1 (77.5) months (p < 0.001). Increased duration of tracheostomy was significantly associated with increased risk of TCF, 27.5 (18.4) version 11.0 (18.2) months (p < 0.001).Stomal maturation was not significantly associated with the risk of TCF, including on multivariable analysis adjusting for age at tracheostomy and duration of tracheostomy (p = 0.089).ConclusionTracheostomy stomal maturation did not affect the risk of TCF in children, even after adjusting for age and duration of tracheostomy.Level of Evidence4 Laryngoscope, 2024

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mentioning

confidence: 68%

Pediatric Tracheotomy Stomal Maturation and Tracheocutaneous Fistulas

Ha,

Jain,

Schuman

et al. 2024

The Laryngoscope

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“…This is likely due to the inherent risk factors of the population. A recent study by Teplitzky et al found that early tracheostomy placement, duration of tracheostomy greater than 2 years, gestational age and chronic respiratory failure were each associated with an increased risk for TCF 18 . These conditions are almost universal among EP patients.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study by Teplitzky et al found that early tracheostomy placement, duration of tracheostomy greater than 2 years, gestational age and chronic respiratory failure were each associated with an increased risk for TCF. 18 These conditions are almost universal among EP patients. To the best of our knowledge, this is the first study to illustrate the increased incidence of TCF in postoperative patients with EP.…”

Section: Discussionmentioning

confidence: 99%

Laryngotracheal Reconstruction Outcomes in Children Born Extremely Premature

et al. 2023

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IntroductionThere has been a notable increase in the number of neonates born 28 weeks gestational age or younger in the United States. Many of these patients require tracheostomy early in life and subsequent laryngotracheal reconstruction (LTR). Although extremely premature infants often undergo LTR, there is no known study to date examining their post‐surgical outcomes.ObjectivesTo compare decannulation rates, time to decannulation and complication rates between LTR patients born extremely premature to those born preterm and term.MethodsWe identified 179 patients treated at a stand‐alone tertiary children's hospital who underwent open airway reconstruction from 2008 to 2021. A Chi Squared test was used to detect differences in categorical clinical data between the groups of patients. A Mann–Whitney test was used to analyze continuous data within these same groups. Time to decannulation analysis was performed using Kaplan Meier analysis and evaluated with log‐rank and Cox proportional hazards regression.ResultsChildren born extremely premature were more likely to incur complications following LTR (OR = 2.363, p = 0.005, CI 1.295–4.247). There was no difference in time to decannulation (p = 0.0543, Log‐rank) or rate of decannulation (OR = 0.4985, p = 0.05, CI 0.2511–1.008). Extremely premature infants were more likely to be treated with an anterior and posterior grafts (OR = 2.471, p = 0.004, CI 1.297–4.535) and/or an airway stent (OR = 3.112, p < 0.001, CI 1.539–5.987).ConclusionCompared with all other patients, extremely premature infants have equivalent decannulation success, but are at an increased risk for complications following LTR.Level of Evidence3 Laryngoscope, 2023

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“…In patients decannulated following double-stage open airway reconstruction, the incidence has been found to be as high as 85% [34]. The most commonly identified risk factor related to TCF formation is duration of tracheostomy, with a cannulation period of over 24 months being most strongly correlated [31,32,33]. Two recent studies identified age at tracheostomy placement, as well as the presence of tracheobronchomalacia or congenital malformations as risk factors [32,33].…”

Section: Tracheocutaneous Fistulamentioning

confidence: 99%

Pediatric tracheostomy decannulation: what's the evidence?

Raynor,

Bedwell

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review Pediatric decannulation failure can be associated with large morbidity and mortality, yet there are no published evidence-based guidelines for pediatric tracheostomy decannulation. Tracheostomy is frequently performed in medically complex children in whom it can be difficult to predict when and how to safely decannulate. Recent findings Published studies regarding pediatric decannulation are limited to reviews and case series from single institutions, with varying populations, indications for tracheostomy, and institutional resources. This article will provide a review of published decannulation protocols over the past 10 years. Endoscopic airway evaluation is required to assess the patency of the airway and address any airway obstruction prior to decannulation. There is considerable variability in tracheostomy tube modification between published protocols, though the majority support a capping trial and downsizing of the tracheostomy tube to facilitate capping. Most protocols include overnight capping in a monitored setting prior to decannulation with observation ranging from 24 to 48 h after decannulation. There is debate regarding which patients should have capped polysomnography (PSG) prior to decannulation, as this exam is resource-intensive and may not be widely available. Persistent tracheocutaneous fistulae are common following decannulation. Excision of the fistula tract with healing by secondary intention has a lower reported operative time, overall complication rate, and postoperative length of stay. Summary Pediatric decannulation should occur in a stepwise process. The ideal decannulation protocol should be safe and expedient, without utilizing excessive healthcare resources. There may be variability in protocols based on patient population or institutional resources, but an explicitly described protocol within each institution is critical to consistent care and quality improvement over time. Further research is needed to identify selection criteria for who would most benefit from PSG prior to decannulation to guide allocation of this limited resource.

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Incidence of Persistent Tracheocutaneous Fistula After Pediatric Tracheostomy Decannulation

Cited by 6 publications

References 32 publications

Pediatric Tracheotomy Stomal Maturation and Tracheocutaneous Fistulas

Pediatric Tracheotomy Stomal Maturation and Tracheocutaneous Fistulas

Laryngotracheal Reconstruction Outcomes in Children Born Extremely Premature

Pediatric tracheostomy decannulation: what's the evidence?

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