Tracheal A‐frame deformity and suprastomal collapse after pediatric tracheostomy
Abstract Objectives To determine the incidence of A‐frame deformity and suprastomal collapse after pediatric tracheostomy. Study design Retrospective cohort. Methods All patients (<18 years) that had a tracheostomy placed at a tertiary institution between 2015 and 2020 were included. Children wit...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-02-01
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| Series: | Laryngoscope Investigative Otolaryngology |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/lio2.1202 |
| _version_ | 1797299321610174464 |
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| author | Rishi Suresh Helene Dabbous Swapnika Alahari Yann‐Fuu Kou Romaine F. Johnson Stephen R. Chorney |
| author_facet | Rishi Suresh Helene Dabbous Swapnika Alahari Yann‐Fuu Kou Romaine F. Johnson Stephen R. Chorney |
| author_sort | Rishi Suresh |
| collection | DOAJ |
| description | Abstract Objectives To determine the incidence of A‐frame deformity and suprastomal collapse after pediatric tracheostomy. Study design Retrospective cohort. Methods All patients (<18 years) that had a tracheostomy placed at a tertiary institution between 2015 and 2020 were included. Children without a surveillance bronchoscopy at least 6 months after tracheostomy were excluded. Operative reports identified tracheal A‐frame deformity or suprastomal collapse. Results A total of 175 children met inclusion with 18% (N = 32) developing A‐frame deformity within a mean of 35.8 months (SD: 19.4) after tracheostomy. For 18 children (18/32, 56%), A‐frame developed within a mean of 11.3 months (SD: 15.7) after decannulation. There were 96 children developing suprastomal collapse (55%) by a mean of 17.7 months (SD: 14.2) after tracheostomy. All suprastomal collapse was identified prior to decannulation. Older age at tracheostomy was associated with a lower likelihood of collapse (OR: 0.92, 95% CI: 0.86–0.99, p = .03). The estimated 5‐year incidence of A‐frame deformity after tracheostomy was 32.8% (95% CI: 23.0–45.3) and the 3‐year incidence after decannulation was 36.1% (95% CI: 24.0–51.8). Highly complex children had an earlier time to A‐frame development (p = .04). At 5 years after tracheostomy, the estimated rate of suprastomal collapse was 73.7% (95% CI: 63.8–82.8). Conclusions Tracheal A‐frame deformity is estimated to occur in 36% of children within 3 years after tracheostomy decannulation. Suprastomal collapse, which approaches 74% at 5 years after tracheostomy, is more common when tracheostomy is placed at a younger age. Surgeons caring for tracheostomy‐dependent children should recognize acquired airway obstruction and appropriately monitor these outcomes. Level of evidence 3. |
| first_indexed | 2024-03-07T22:48:54Z |
| format | Article |
| id | doaj.art-d2771a6d23b242c5a6d47fdcd149977e |
| institution | Directory Open Access Journal |
| issn | 2378-8038 |
| language | English |
| last_indexed | 2024-03-07T22:48:54Z |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Laryngoscope Investigative Otolaryngology |
| spelling | doaj.art-d2771a6d23b242c5a6d47fdcd149977e2024-02-23T12:00:37ZengWileyLaryngoscope Investigative Otolaryngology2378-80382024-02-0191n/an/a10.1002/lio2.1202Tracheal A‐frame deformity and suprastomal collapse after pediatric tracheostomyRishi Suresh0Helene Dabbous1Swapnika Alahari2Yann‐Fuu Kou3Romaine F. Johnson4Stephen R. Chorney5Department of Otolaryngology – Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USADepartment of Otolaryngology‐Head and Neck Surgery West Virginia University Morgantown West Virginia USAUniversity of Texas Southwestern School of Medicine Dallas Texas USADepartment of Otolaryngology – Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USADepartment of Otolaryngology – Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USADepartment of Otolaryngology – Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USAAbstract Objectives To determine the incidence of A‐frame deformity and suprastomal collapse after pediatric tracheostomy. Study design Retrospective cohort. Methods All patients (<18 years) that had a tracheostomy placed at a tertiary institution between 2015 and 2020 were included. Children without a surveillance bronchoscopy at least 6 months after tracheostomy were excluded. Operative reports identified tracheal A‐frame deformity or suprastomal collapse. Results A total of 175 children met inclusion with 18% (N = 32) developing A‐frame deformity within a mean of 35.8 months (SD: 19.4) after tracheostomy. For 18 children (18/32, 56%), A‐frame developed within a mean of 11.3 months (SD: 15.7) after decannulation. There were 96 children developing suprastomal collapse (55%) by a mean of 17.7 months (SD: 14.2) after tracheostomy. All suprastomal collapse was identified prior to decannulation. Older age at tracheostomy was associated with a lower likelihood of collapse (OR: 0.92, 95% CI: 0.86–0.99, p = .03). The estimated 5‐year incidence of A‐frame deformity after tracheostomy was 32.8% (95% CI: 23.0–45.3) and the 3‐year incidence after decannulation was 36.1% (95% CI: 24.0–51.8). Highly complex children had an earlier time to A‐frame development (p = .04). At 5 years after tracheostomy, the estimated rate of suprastomal collapse was 73.7% (95% CI: 63.8–82.8). Conclusions Tracheal A‐frame deformity is estimated to occur in 36% of children within 3 years after tracheostomy decannulation. Suprastomal collapse, which approaches 74% at 5 years after tracheostomy, is more common when tracheostomy is placed at a younger age. Surgeons caring for tracheostomy‐dependent children should recognize acquired airway obstruction and appropriately monitor these outcomes. Level of evidence 3.https://doi.org/10.1002/lio2.1202pediatric tracheostomysuprastomal collapsetracheal A‐frame deformity |
| spellingShingle | Rishi Suresh Helene Dabbous Swapnika Alahari Yann‐Fuu Kou Romaine F. Johnson Stephen R. Chorney Tracheal A‐frame deformity and suprastomal collapse after pediatric tracheostomy Laryngoscope Investigative Otolaryngology pediatric tracheostomy suprastomal collapse tracheal A‐frame deformity |
| title | Tracheal A‐frame deformity and suprastomal collapse after pediatric tracheostomy |
| title_full | Tracheal A‐frame deformity and suprastomal collapse after pediatric tracheostomy |
| title_fullStr | Tracheal A‐frame deformity and suprastomal collapse after pediatric tracheostomy |
| title_full_unstemmed | Tracheal A‐frame deformity and suprastomal collapse after pediatric tracheostomy |
| title_short | Tracheal A‐frame deformity and suprastomal collapse after pediatric tracheostomy |
| title_sort | tracheal a frame deformity and suprastomal collapse after pediatric tracheostomy |
| topic | pediatric tracheostomy suprastomal collapse tracheal A‐frame deformity |
| url | https://doi.org/10.1002/lio2.1202 |
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