P3B062: Trends in Tracheostomy: Institutional Experience over 10 Years

Background: Pediatric tracheostomy is considered a safe procedure and has become an accepted means of coping with a multitude of pediatric disorders such as prolonged ventilation due to HIE, BPD, neuromuscular disease, and trauma. Palliative care physicians need a complete understanding of outcomes in order to inform the counseling of parents and families regarding the decision to pursue tracheostomy. As the indication for tracheostomy and the incidence of the procedure has changed, long-term outcomes have also changed.

Methods: The authors performed a retrospective chart review of all patients at Nicklaus Children's Hospital that underwent tracheostomy from 2013-2022. Demographic data collected included gender, ethnicity, indication, age at tracheostomy, decannulation, mortality, length of stay, rehospitalizations, and complications. Patients with tracheostomies not performed at our institution or over the age of 18 were excluded.

Results: We found 245 patients who had undergone tracheostomy. In 2013 there were 7 tracheostomies performed. Each successive year showed an increase in the number of tracheostomies. The highest number occurred in 2019 with 38. n 2022 there were 24 tracheostomies performed. 63.7% of patients were less than one year of age at the time of tracheostomy. The length of stay was prolonged with 30 patients having a stay greater than 300 days. 30.2% of patients required re-hospitalization due to complications or pneumonia. 11% (28) of the cohort were decannulated after an average time of tracheostomy dependence of 2.2 years. 14% (7) of the decannulated patients failed decannulation and required a new tracheostomy. The leading indication for tracheostomy was neurologic disease or impairment (38%).

Conclusion: Over the past ten years, there has been an increase in the number of pediatric tracheostomies performed at our institution. The leading indication for tracheostomy is neurologic impairment. The overwhelming number of patients undergoing tracheostomy were infants and the number of patients who were successfully decannulated was less than 10%. This data will help inform practitioners and counsel families on complex decision-making surrounding tracheostomy.