Impact of stoma maturation on pediatric tracheostomy-related complications

Kathryn L Colman, David L Mandell, Jeffrey P Simons
Archives of Otolaryngology—Head & Neck Surgery 2010, 136 (5): 471-4

OBJECTIVES: To assess the impact of stoma maturation on pediatric tracheostomy-related complications and to report the incidence of pediatric tracheostomy-related complications.

DESIGN: Retrospective medical chart review and data analysis.

SETTING: Tertiary care children's hospital.

PATIENTS: A total of 172 consecutive patients who underwent tracheotomy during a 4-year period.

INTERVENTION: Tracheotomy with or without stoma maturation at the time of surgery was performed by 8 pediatric otolaryngologists. Stoma maturation was based solely on individual surgeon preference, not on patient factors.

MAIN OUTCOME MEASURES: Early and late tracheostomy-related complications; correlation between stoma maturation and complication rate.

RESULTS: The patients' mean (SD) age was 4.9 (6.6) years, with a mean follow-up of 35.4 (24.5) months. Of 156 patients for whom stoma maturation data were available, 48 (30.8%) underwent stoma maturation and 108 (69.2%) did not. Nineteen of 172 patients (11.0%) had an early complication (within the first 7 days), including accidental decannulation, bleeding, false tract, pneumonia, and tracheitis. Late complications included suprastomal tracheal granulation tissue (48.8%), tracheitis (48.8%), peristomal granulation tissue (26.7%), accidental decannulation (11.6%), and mucus plugging (9.9%). Among the 62 patients (36.0%) who were decannulated, 23 of 62 (37.1%) developed a persistent tracheocutaneous fistula. Younger patients had a higher rate of suprastomal granulation tissue, tracheitis, tracheocutaneous fistula, and repeated surgical procedures (P < .05). Patients with stoma maturation were incidentally older than patients without stoma maturation (P < .05). When corrected for age, stoma maturation did not have an impact on the incidence of any of the tracheostomy-related complications.

CONCLUSION: There was no relationship between stoma maturation and tracheostomy-related complications, including rate of tracheocutaneous fistula and development of granulation tissue.

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