Tracheal A‐frame deformity and suprastomal collapse after pediatric tracheostomy

Abstract

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.

Keywords

• pediatric tracheostomy
• suprastomal collapse
• tracheal A‐frame deformity