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Original Investigation |

Complications Following Pediatric Tracheotomy

Jill N. D’Souza, MD1; Jessica R. Levi, MD2; David Park, BA2; Udayan K. Shah, MD1,3,4
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
2Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts
3Department of Otolaryngology–Head and Neck Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
4Department of Pediatrics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
JAMA Otolaryngol Head Neck Surg. 2016;142(5):484-488. doi:10.1001/jamaoto.2016.0173.
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Importance  Pediatric tracheotomy is a complex procedure with significant postoperative complications. Wound-related complications are increasingly reported and can have considerable impact on clinical course and health care costs to tracheotomy-dependent children.

Objective  The primary objective of this study was to identify the type and rate of complications arising from pediatric tracheotomy.

Design, Setting, and Participants  A retrospective review of medical records of 302 children who underwent tracheotomy between December 1, 2000, and February 28, 2014, at a tertiary care pediatric referral center. Records were reviewed for preoperative diagnoses, gestational age, age at tracheotomy, tracheotomy technique, and incidence of complication.

Main Outcomes and Measures  Main outcome measures included incidence, type, and timing of complications. Secondary measures included medical diagnoses and surgical technique.

Results  Of the 302 children who underwent tracheotomy, the median (SD) age at time of tracheotomy was 5 months (64 months) and the range was birth to 21 years. The most frequent diagnosis associated with performance of a tracheotomy was ventilator-associated respiratory failure (61.9%), followed by airway anomaly or underdevelopment (25.2%), such as subglottic or tracheal stenosis, laryngotracheomalacia, or bronchopulmonary dysplasia. The remaining indications for tracheotomy included airway obstruction (11.6% [35 of 302]) and vocal fold dysfunction (1.3% [4 of 302]). No statistical significance was found associated with diagnosis and incidence of complications. Sixty children (19.9%) had a tracheotomy-related complication. Major complications, such as accidental decannulation (1.0% [3 of 302]). There were no deaths associated with tracheotomy. Minor complications, such as peristomal wound breakdown or granuloma (12.9% [39 of 302]) and bleeding from stoma (1.7% [5 of 302]), were more common. Of all complications, 70% (42 of 60) occurred early (≤7 days postoperatively) and 20% (12 of 60) were late (>7 days postoperatively).

Conclusions and Relevance  Pediatric tracheotomy at our institution is associated with an overall 19.9% incidence of complications. Although the rate of major complications such as accidental decannulation or death is low, rates of peristomal skin breakdown and development of granuloma are more frequently reported and can occur at any point following tracheotomy. Further work is necessary to understand and mitigate wound care issues in post-tracheotomy care.

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Figure 1.
Age Distribution of Pediatric Patients Undergoing Tracheotomy at Nemours/Alfred I. duPont Hospital for Children During the Study Period
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Figure 2.
Incidence of Complications Following Pediatric Tracheotomy
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