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Persistent Tracheocutaneous Fistula Seen in More Than Half of Decannulated Children

by Linda Kossoff •

What is the incidence of tracheocutaneous fistulas (TCF) among decannulated children and what are the risk factors and comorbidities associated with its persistence?

BOTTOM LINE

Two-thirds of children will develop a persistent TCF after tracheostomy decannulation; correlations to persistent TCF include young age, longer procedure duration, and congenital malformations.

BACKGROUND: A tracheocutaneous fistula (TCF) commonly persists after pediatric tracheostomy decannulation, potentially preventing tract closure and negatively impacting phonation, swallowing, and cough physiology. Additional negative effects can contribute to patient morbidity and caregiver disappointment. Evidence on TCF in children is limited, but recent reviews suggest an incidence greater than previously estimated.

STUDY DESIGN: Prospective cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

SYNOPSIS: Researchers used the Children’s Health Airway Management Program database to identify pediatric patients who were successfully decannulated between 2014 and 2020 at a tertiary children’s hospital. They excluded cases involving revision tracheostomies, concomitant major neck surgery, or single-stage laryngotracheal reconstructions. The primary outcome was a persistent TCF, defined as at least six weeks after decannulation. Of the 77 children who met the criteria, 50 (65%) experienced a persistent TCF. Of these 50, 43 (86%) underwent surgical TCF repair. Persistent TCF was associated with younger age at placement (mean 1.4 years vs. 8.5 years for spontaneous TCF closure), longer tracheostomy dependence, shorter gestational age, and lower birth weight. Comparisons of comorbidities of decannulated children between persistent vs. spontaneous TCF closure showed the following: short gestation 64% vs. 26%, congenital malformations 64% vs. 33%, newborn complications 58% vs. 26%, and maternal complications 40% vs. 11%, respectively. Authors say these findings could help facilitate more thoughtful patient management, and guide parent and caregiver expectations. Study limitations included the omission of tracheostomy tube inner diameter information.

CITATION: Teplitzky TB, Kou YF, Beams DR, et al. Incidence of persistent tracheocutaneous fistula after pediatric tracheostomy decannulation. Laryngoscope. 2023;133:417–422.