(1065) The Impact of Maturation Sutures on False Passage Formation in Pediatric Tracheostomy

Introduction: Tracheostomy is a common but high-risk procedure in children. False passage (FP) is an infrequent but life-threatening complication of tracheostomy. Many surgeons mature the stoma in pediatric patients, but it is not known whether maturation sutures decrease the risk of FP. Our objective is to evaluate the impact of using maturation sutures on FP in pediatric tracheostomy.

Methods: A retrospective review of children who underwent tracheostomy (2007-2023) was performed. Records were reviewed for demographics, procedural details including use of maturation sutures. Outcomes included incidence of FP, time to FP and associated complications resulting from FP.

Results: 70 children were included. Median age at tracheostomy was 0.5 (IQR 0.2-4.2) years and median weight at tracheostomy was 5.3 (IQR 4.1-13.6) kg. Indications for tracheostomy were airway obstruction (34.3% [24/70]), chronic ventilation (32.9% [23/70]) and prolonged intubation (22.9% [16/70]).
Maturation sutures were used in 36 children (51.4%). 4-point maturation was used in 61.1% (22/36) and 2-point (19.4% (7/36) of children. 44 children (62.9%) had NEO tubes, 17 (24.3%) had PED tubes, and 9 (12.9%) had ADULT tubes.
The incidence of FP was 5.7% (4/70). None of the patients who developed FP had 4-point maturation sutures, 3 had no maturation sutures and 1 had 2-point sutures. Median time to FP was 12.0 (IQR 9-13) days. Complications in the 4 children with FP included respiratory distress, pneumothorax), pneumomediastinum (n=1), subcutaneous emphysema (n=1), and cardiac arrest (n=1). There were no deaths associated with FP.

Conclusions: FP typically occurs within 2 weeks of initial tracheostomy placement and is associated with absence of maturation sutures used in the initial placement. Major respiratory complications from FP can be avoided.