Elsevier

Journal of Pediatric Surgery

Volume 49, Issue 11, November 2014, Pages 1549-1553
Journal of Pediatric Surgery

Original Article
Changes in pediatric tracheostomy 1982–2011: a Canadian tertiary children's hospital review

https://doi.org/10.1016/j.jpedsurg.2014.04.014Get rights and content

Abstract

Background

Pediatric tracheostomy has undergone notable changes in frequency and indication over the past 30 years. This study investigates pediatric tracheostomy at British Columbia Children's Hospital (BCCH) over a 30-year period.

Methods

A retrospective chart review of tracheostomy cases at BCCH from 1982 to 2011 was conducted. Charts were reviewed for demographics, date of tracheostomy, indication, complications, mortality and date of decannulation. Data from three 10-year time periods were compared using Fisher's Exact test to examine changes over time.

Results

251 procedures (154 males) performed on 231 patients were reviewed. Mean age at tracheostomy was 3.74 years with 48% of procedures undertaken before the age of one year. Frequency of procedure by year has generally declined into the early 2000's. Upper airway obstruction was the most common indication accounting for 33% of procedures. The rate of complication across the entire cohort was 22% with 63% of patients being decannulated. Tracheostomy related mortality occurred in 2.0% of cases reviewed.

Conclusions

Changes occurred in primary indications with infections indicating less procedures and neurological impairments indicating more procedures over time. Complications increased and the decannulation rate decreased over this 30-year review. Pediatric tracheostomy is considered a safe and effective procedure at BCCH.

Section snippets

Methods

A retrospective chart review of all tracheostomy cases performed at BCCH from 1982 to 2011 with follow-up review until 2011 was conducted. Ethical approval was obtained from the University of British Columbia/Children's and Women's Health Centre of British Columbia Research Ethics Board. All tracheostomy procedures over the 30 year period were done by 11 surgeons with varying levels of experience using commonly practiced tracheostomy techniques. The majority of tracheal incisions were made

Results

Two hundred and sixty seven tracheostomies were performed at BCCH from 1982 to 2011. This review includes 251 procedures performed on 231 patients (154 male, 97 female), 16 patients were excluded owing to inability to access records. In 16 of the 251 cases (6%) reviewed, complete information could not be found; however, the information that was available from these patient charts was included in analysis and n values were adjusted to reflect missing patients. For the entire cohort, average age

Discussion

At BCCH frequency of tracheostomy has declined over the 1990's and into the 2000's. In the most recent 10 years of this review there has been a plateau and slight increase in the number of procedures performed. This pattern is generally consistent with the current literature, although the plateau has been reported to start earlier [10]. Some spikes in frequency may be explained by corresponding increases in premature infants for that year, however not all spikes show this corresponding increase.

Conclusions

At BCCH patients with a tracheostomy have changed in relation to frequency, indications, complications and decannulation rates over the last 30 years. This review presents an increase in complications over time and decrease in percent decannulated, as indicated by the changes from the first ten year time period to the second. These changes may be the result of increased length of time in situ and complexity of indication for the average tracheostomy patient. Overall, low rates of complication

Acknowledgments

Rachelle Dar Santos- for administrative assistance.

Current and former members of the Division of Pediatric Otolaryngology.

All surgeons who have performed a tracheostomy at BCCH.

References (31)

  • R.F. Ward et al.

    Current trends in pediatric tracheotomy

    Int J Pediatr Otorhinolaryngol

    (1995)
  • P.J. Hadfield et al.

    The changing indications for paediatric tracheostomy

    Int J Pediatr Otorhinolaryngol

    (2003)
  • M.J. Donnelly et al.

    A twenty year (1971–1990) review of tracheostomies in a major paediatric hospital

    Int J Pediatr Otorhinolaryngol

    (1996)
  • A. Rozsasi et al.

    A single-center 6-year with two types of pediatric tracheostomy

    Int J Pediatr Otorhinolaryngol

    (2005)
  • S. Atmaca et al.

    Pediatric tracheotomy: 3-year experience at a tertiary care center with 54 children

    Turk J Pediatr

    (2011)
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