Long‐Term Outcomes of Tracheostomy‐Dependent Children

Abstract

AbstractObjectiveTo estimate the 1‐, 5‐, and 10‐year survival and decannulation rates of children with a tracheostomy.Study DesignAmbidirectional cohort.SettingTertiary children's hospital.MethodsAll patients (<18 years) that had a tracheostomy placed between 2009 and 2020 were included and followed until 21 years of age, decannulation, or death. The Kaplan‐Meier method estimated cumulative probabilities of death and decannulation.ResultsA total of 551 children underwent tracheostomy at a median age of 7.2 months (interquartile range [IQR]: 3.8‐49.2). Children were followed for a median of 2.1 years (IQR: 0.7‐4.2, range 0‐11.5). The cumulative probability of mortality at 1 year was 11.9% (95% confidence interval [CI]: 9.4‐15.1), at 5 years was 26.1% (95% CI: 21.6‐31.3), and at 10 years was 41.6% (95% CI: 32.7‐51.8). Ventilator dependence at index discharge (hazard ratio [HR]: 2.04, 95% CI: 1.10‐3.81, p = .03), severe neurologic disability (HR: 2.79, 95% CI: 1.61‐4.84, p < .001), and cardiac disease (HR: 1.69, 95% CI: 1.08‐2.65, p = .02) were associated with time to death. The cumulative probability of decannulation was 10.4% (95% CI: 8.0‐13.5), 44.9% (95% CI: 39.4‐50.9), and 54.1% (95% CI: 47.4‐61.1) at 1 year, 5 years, and 10 years, respectively. Ventilator dependence (HR: 0.43, 95% CI: 0.31‐0.60, p < .001), severe neurologic disability (HR: 0.20, 95% CI: 0.14‐0.30, p < .001), and tracheostomy indicated for respiratory failure (HR: 0.68, 95% CI: 0.48‐0.96, p = .03) correlated with longer decannulation times.ConclusionAfter tracheostomy, estimated mortality approaches 42% by 10 years and decannulation approaches 54%. Children with ventilator support at discharge and severe neurological disability had poorer long‐term survival and longer times to decannulation.