Review of pediatric tracheotomies and long-term outcomes performed in a low-middle-income country

Objectives: Pediatric tracheotomy is a unique challenge. In resource-constrained settings, little is known regarding long-term outcomes, and even less is published. We aimed to present characteristics and long-term outcomes of tracheotomized children in a low-middle-income country and compare our findings to existing literature. Materials and Methods: Retrospective review of all tracheotomized children at a tertiary hospital from 1994 to 2023. Variables included age at the time of tracheotomy, duration, decannulation, and mortality. Indication was stratified into 8 categories: Laryngeal upper airway obstruction (UAO); midface/skeletal UAO, other UAO; congenital muscular disease; congenital/acquired neurological disease; traumas; cardiopulmonary. Results: A total of 671 patients received tracheotomies, one of whom did not have an indication. The most and least common indication categories were laryngeal UAO (160/670; 23.9%) and cardiopulmonary (41/670; 6.1%), respectively. Overall rate of decannulation was 59.9% (323/670), and mortality was 19.6% (131/670). Laryngeal UAO patients were decannulated at a rate of 53.1% (85/160) with a mortality of 13.1% (21/160). Time to mortality was highest in the congenital neurologic group (median 36 months; interquartile range 16–64). Conclusion: This study summarizes the natural history, ventilation, and decannulation of tracheotomized children at a tertiary hospital. It provides insightful information regarding long-term outcomes of tracheotomized children and provides valuable data to help guide clinicians. Despite disparities in healthcare provisions in this region, children are successfully decannulated, and outcomes are comparable to the literature from higher-income countries.