Association of Care Engagement and Psychosocial Factors With Tracheostomy Decannulation.

OBJECTIVE: To evaluate associations between care engagement and psychosocial factors and decannulation success and timing among adults with laryngotracheal stenosis and tracheostomy dependence. METHODS: This retrospective cohort study included 60 adults with tracheostomy dependence in the setting of laryngotracheal stenosis who underwent airway surgery between September 2021 and November 2025. Patient demographics, clinical history, psychiatric and substance use history, tracheostomy information, surgical information, and follow-up care were extracted from electronic medical records. Fisher's exact tests, chi-squared tests, and accelerated failure time models were used to assess associations with decannulation timing and success. RESULTS: Forty-seven patients (78.3%) achieved decannulation. No significant differences in ability to decannulate were found based on age, sex, race, body mass index (BMI), comorbidities, reason for tracheostomy, or stenosis characteristics. Patients who were not decannulated had significantly higher rates of missed appointments (38.5% vs. 8.5% with ≥ 2 no-shows, p = 0.025) and were more frequently lost to follow-up (p < 0.001). Each missed appointment was associated with a 25% increase in time to decannulation (p = 0.004). Patients with psychiatric diagnoses had a longer time to decannulation, though this relationship was not statistically significant (p = 0.091). Substance use diagnosis, distance to hospital, social vulnerability index, emergency department visits, and complications were not significantly associated with outcomes. CONCLUSION: Care engagement patterns, including better appointment adherence, were significantly associated with improved decannulation rates in patients with laryngotracheal stenosis. Psychiatric comorbidities may delay decannulation. These findings suggest that interventions targeting consistent follow-up and mental health support may improve tracheostomy outcomes in this complex patient population. LEVEL OF EVIDENCE: 4.