Outcome in pediatric tracheotomy

OBJECTIVE: To investigate the outcome and related factors in pediatric tracheotomy. DESIGN: Retrospective chart review. SETTING: Tertiary pediatric academic hospital setting. PATIENTS: The study included 181 children below the age of 18 years who underwent 185 tracheotomies between 1991 and 1995. MAIN OUTCOMES AND MEASURES: Presenting symptoms and signs, indications, duration of follow-up, therapeutic and interval procedures, early and late complications, mortality, time to and success in decannulation. RESULTS: There were 108 (59.7%) male patients and 73 (40.3%) female patients. The average age of the children at the time of tracheotomy was 3.8 +/- 5.3 years. The majority of the children were less than 1 year of age (n = 99, 54.7%). Airway obstruction was the leading indication for tracheotomy (59.6%), followed by ventilatory support (30.4%) and pulmonary toilet (9.9%). The average duration of follow-up was 931 +/- 790 days. There were no perioperative complications. Early postoperative complications were seen in 28 (15.5%) children including 12 (6.8%) major complications and 22 (12.2%) minor complications. Late complications were seen in 115 (63.5%) children, including 8 (4.4%) major complications and 107 (59.1%) minor complications. Overall mortality rate was 13.3%, but only 1 tracheotomy-related death was caused by tube displacement. Therapeutic procedures were performed in 43% of the children, including laryngotracheal reconstruction (13%), laser excision of the lesion (5%), and supraglottoplasty (3.9%). Decannulation was accomplished in 116 (64.1%) of the children with an average of 365 +/- 388 days with tracheotomy. CONCLUSION: Tracheotomy is relatively safe in the pediatric population. Decannulation may be possible relatively quickly with resolution of the underlying problem.