Change over time in intensive care unit transition after pediatric tracheotomy: A 28-year analysis of shifting outcomes.

OBJECTIVE: To compare pediatric tracheotomy outcomes between earlier and recent treatment eras and assess whether differ in post-tracheotomy intensive care unit (ICU) hospitalization. METHODS: This retrospective cohort study reviewed children age ≤ 18 who underwent tracheotomy between 1997 and 2024 at a tertiary children's hospital. Patients were categorized into an early era (1997-2011) and a late era (2012-2024). Clinical indicators of disease severity, including age at tracheotomy, primary indication for tracheotomy, pre-tracheotomy duration of intubation, and comorbidity burden, were evaluated. The primary outcome was time from tracheotomy to ICU discharge. Kaplan-Meier analysis and multivariable Cox proportional hazards models were used to assess the association between era and time from tracheotomy to ICU discharge. RESULTS: A total of 257 children were included. Age and sex did not differ between eras. Baseline demographic characteristics were similar between eras. Children treated in the late era had significantly longer time to ICU discharge than those in the early era (31.3 vs. 14.7 days, p < 0.001) and were more likely to require home ventilatory support after discharge (23.4% vs. 9.3%, p = 0.007). After adjustment for key clinical indicators of disease severity, the later era remained independently associated with a lower likelihood of ICU discharge. CONCLUSION: Differences between eras were observed in time to ICU discharge after pediatric tracheotomy, with longer time to ICU discharge in the later era despite adjustment for clinical indicators of disease severity. These findings suggest that the observed differences persisted after adjustment for measured patient factors, while residual confounding cannot be excluded, and may reflect changes in clinical practices, ventilatory support needs and care-transition processes.