Tracheal A‐frame deformity and suprastomal collapse after pediatric tracheostomy

Abstract

ObjectivesTo determine the incidence of A‐frame deformity and suprastomal collapse after pediatric tracheostomy.Study designRetrospective cohort.MethodsAll patients (<18 years) that had a tracheostomy placed at a tertiary institution between 2015 and 2020 were included. Children without a surveillance bronchoscopy at least 6 months after tracheostomy were excluded. Operative reports identified tracheal A‐frame deformity or suprastomal collapse.ResultsA total of 175 children met inclusion with 18% (N = 32) developing A‐frame deformity within a mean of 35.8 months (SD: 19.4) after tracheostomy. For 18 children (18/32, 56%), A‐frame developed within a mean of 11.3 months (SD: 15.7) after decannulation. There were 96 children developing suprastomal collapse (55%) by a mean of 17.7 months (SD: 14.2) after tracheostomy. All suprastomal collapse was identified prior to decannulation. Older age at tracheostomy was associated with a lower likelihood of collapse (OR: 0.92, 95% CI: 0.86–0.99, p = .03). The estimated 5‐year incidence of A‐frame deformity after tracheostomy was 32.8% (95% CI: 23.0–45.3) and the 3‐year incidence after decannulation was 36.1% (95% CI: 24.0–51.8). Highly complex children had an earlier time to A‐frame development (p = .04). At 5 years after tracheostomy, the estimated rate of suprastomal collapse was 73.7% (95% CI: 63.8–82.8).ConclusionsTracheal A‐frame deformity is estimated to occur in 36% of children within 3 years after tracheostomy decannulation. Suprastomal collapse, which approaches 74% at 5 years after tracheostomy, is more common when tracheostomy is placed at a younger age. Surgeons caring for tracheostomy‐dependent children should recognize acquired airway obstruction and appropriately monitor these outcomes.Level of evidence3.