# Tracheostomy Duration Is a Key Predictor of Persistent Tracheocutaneous Fistulas in Children

## TL;DR

The study finds that longer tracheostomy duration increases the risk of persistent tracheocutaneous fistulas in children after decannulation.

## Contribution

The study identifies tracheostomy duration as a key predictor of persistent tracheocutaneous fistulas in pediatric patients.

## Key findings

- 63.2% of patients had spontaneous closure of tracheocutaneous fistulas.
- Prolonged tracheostomy duration (over 12 months) significantly increased the need for surgical closure.
- Neurologic comorbidities and laryngotracheomalacia were not significant risk factors.

## Abstract

Introduction

Pediatric tracheostomy is a surgical procedure that secures the airway in children with upper airway obstruction or those in need of pulmonary support. Persistent tracheocutaneous fistula is a potential sequela that can occur after the decannulation process.

Objectives

To evaluate the frequency and risk factors that lead to a persistent tracheocutaneous fistula.

Material and methods

This is a retrospective analysis of pediatric patients who underwent tracheostomy decannulation in a tertiary hospital from 2008 to 2021.

Results

Nineteen patients, ranging from 6 days to 17 years old, underwent tracheostomy and were later decannulated. Twelve cases (63.2%) closed spontaneously while 7 patients (36.8%) required surgical closure of the tracheocutaneous fistula. Variables such as neurologic comorbidities, laryngotracheomalacia, and prolonged ventilation did not show statistically significant differences between the two groups. The mean tracheostomy duration was 7.8 and 26.7 months for spontaneous and surgical closure of a tracheocutaneous fistula, respectively. Most of the spontaneous closures (83.3%) occurred after 1.5 months. When comparing surgical and spontaneous closure, those needing surgical closure had a tracheostomy for a longer time (p=0.022), especially if the tracheostomy tube was placed more than 12 months (p=0.045).

Conclusion

In this series, most patients had a spontaneous closure of the tracheocutaneous fistula. The main factor for a persistent tracheocutaneous fistula was prolonged tracheostomy, which may be considered an outcome predictor whenever decannulation is planned.