(1027) Fenestrated Versus Conventional Pediatric Tracheotomy: Is There a Difference in Complications?

Introduction: Fenestrated tracheotomy (FT) with sutured flaps forms a “permanent” stoma and may reduce early risks of the procedure. The aim of this study was to determine if FT in children is associated with reduced postop hospital resource utilization as demonstrated by complications, days in hospital, and return to operating room (OR).

Methods: A retrospective study was conducted using the ACS NSQIP-P database. Patients aged 18 years or younger who underwent tracheotomy from January 2020 to December 2021 were identified using CPT codes 31600: ‘Tracheostomy, Planned’, 31601: ‘Tracheostomy, Planned < 2 years,' and 31610: ‘Tracheostomy, Fenestration Procedure with Skin Flaps.’ CPT 31610 (FT) was compared to CPT 31600 and 31601 (Conventional tracheotomy, CT) together. Variables investigated were 30-day mortality, pneumonia, reintubation, readmission related to the procedure, return to OR related to the procedure, days from operation to discharge, and length of stay (LOS). Comparisons were made with non-parametric statistics.

Results: In total, 2,352 patients were included with mean age of 2.9 ± 4.9 years (1,045 (44.4%) female, 1,306 (55.5%) male, 2 (0.1%) non-binary). 1,973 (83.8%) underwent CT and 381 (16.2%) underwent FT. There were no significant differences in age or gender between groups. The FT group was significantly less likely to return to the OR (2/381, 0.5%) than the CT group (65/1973, 3.3%, p < 0.01). For both groups, the most common reasons for return to OR were tracheostomy tube change (21/67, 31.3%) and direct laryngoscopy (19/67, 28.4%). The FT group was more likely to develop postop pneumonia (32/381, 8.5%) than the CT group (104/1,973, 5.3%, p < 0.05). Despite a higher risk of pneumonia, no significant differences were found in 30-day mortality, reintubation, readmission related to the procedure, days from operation to discharge, and LOS.

Conclusions: Fenestrated tracheotomy results in significantly fewer returns to OR but no difference in LOS or readmissions. This early advantage may be offset during future decannulation attempts.