Morbidity, mortality, and follow-up after pediatric tracheostomy: A national cohort study

OBJECTIVE: To describe the clinical characteristics, quantify complications, analyze mortality, and identify the clinical factors associated with increased need for otorhinolaryngology (ENT) follow-up visits in pediatric patients with a tracheostomy. DESIGN: Retrospective cohort study. SETTING: A single tertiary referral centre performing all pediatric tracheostomies in Slovenia. PATIENTS: 43 patients younger than 16 years undergoing tracheostomy between January 1st, 2018, and December 31st, 2022. METHODS AND RESULTS: Electronic medical records were analyzed for age at tracheostomy (median: 197.0 days, IQR: 78.0-1951.0), type of tracheal cannula, intubation duration prior to tracheostomy (median: 35.0 days, IQR: 13.0-68.0), tracheostomy indications, comorbidities, tracheostomy-related complications, dysphagia with aspiration, number of ENT follow-up visits (median: 13.0, IQR: 6.0-20.0), follow up duration (median: 723 days, IQR: 374.0-1479) and mortality. The most common indication for tracheostomy was long-term ventilation (25/43; 58.1%). Early complications occurred in 12/43 patients (27.9%), while late complications affected 22/43 patients (51.2%). Eight patients (18.6%) developed post-intubation laryngeal stenosis. We identified upper airway obstruction as an indication for tracheostomy (p = 0.001) and the presence of post-intubation laryngeal stenosis (p = 0.021) to be independent risk factors for increased ENT follow-up visits. Seven patients (16.3%) died; no deaths were tracheostomy-related. CONCLUSIONS: Pediatric tracheostomy was associated with frequent complications. Mortality was not related to the presence of tracheostomy. Children tracheostomized for upper airway obstruction, and those with post-intubation laryngeal stenosis required significantly more ENT follow-up visits.