Time Considerations and Outcomes in Pediatric Tracheostomy Decannulation

Introduction: Tracheostomy-dependence in the pediatric population contributes to psychologic and economic stressors. While decannulation aims to remove these stressors, it is time-variable. We sought to identify factors that impact the decannulation process.

Methods: Comprehensive chart review utilizing billing codes from January 1, 2005 through December 31, 2020 identified pediatric patients with tracheostomy at a tertiary pediatric hospital. Data abstracted included demographic, socioeconomic factors, and clinical characteristics. Multivariate regression and survival analysis were used to identify factors associated with successful decannulation and decreased time to decannulation.

Results: Of the 479 tracheostomy-dependent patients identified, 162 (33.8%) were decannulated. Time to decannulation ranged from 0.5 months to 189.2 months with mean of 34.6 months. In the multivariate analysis, patients with BPD and those with PMV at discharge were significantly associated with decannulation. In contrast, neurologic comorbidities, presence of gastrostomy tube, or discharged on a home ventilator were associated with indefinite tracheostomy. When adjusting for age, sex, race, ethnicity, and insurance status, for every one month delay in establishment of outpatient care, time to decannulation was delayed by 0.5 months. For each additional outpatient follow up visit, time to decannulation increased by 3.36 months.

Conclusions: Timely establishment of outpatient care for following hospitalization requiring pediatric tracheostomy significantly decreases time to decannulation.