Factors associated with delayed decannulation within 180 days after pediatric tracheostomy in the PICU: a retrospective cohort study.

INTRODUCTION: Long-term decannulation outcomes after pediatric tracheostomy, particularly among children discharged from the pediatric intensive care unit (PICU), remain poorly described. This study aimed to describe the long-term decannulation outcomes and factors associated with delayed decannulation within 180 days after hospital discharge. METHODS: We retrospectively reviewed children aged 29 days to 18 years who underwent first-time tracheostomy in the PICU of Beijing Children's Hospital between January 2016 and December 2020. Follow-up data were obtained from medical records and standardized telephone interviews through August 31, 2025. The cumulative decannulation rate was estimated using the Kaplan-Meier analysis. Factors associated with delayed decannulation were analyzed using Cox regression. The discriminative ability of the independently associated factors in combination was assessed using receiver operating characteristic (ROC) curve analysis. RESULTS: Among 234 children who underwent tracheostomy, 121 survivors with complete follow-up data were included in the final analysis. The median age at tracheostomy was 60 months (IQR, 15-111 months), and 30 patients (24.8%) were aged ≤1 year. At least one post-tracheostomy complication occurred in 66 children (54.5%), with late complications occurring in 62 children (51.2%). During final follow-up, 106 patients (87.6%) achieved successful decannulation, with a median time to decannulation of 126 days (IQR, 68-332). Within 180 days after discharge, 62 children (51.2%) achieved successful decannulation. Multivariable Cox regression analysis showed that age ≤1 year, obstructive airway disease, and poor cough reflex were independently associated with delayed decannulation within 180 days. The combination of these factors showed good discriminatory ability for 180-day decannulation status (AUC, 0.854; 95% CI, 0.783-0.926). CONCLUSIONS: Prolonged tracheostomy dependence was common after PICU discharge, with approximately half of children remaining cannulated at 180 days. Infancy, obstructive airway disease, and poor cough reflex were independently associated with delayed decannulation. Ventilator dependence and late complications were also associated with delayed decannulation. These late complications included respiratory infections, tube-related events, swallowing or phonation disorders, granulation tissue formation, tracheocutaneous fistula, and tracheal stenosis or malacia. These findings highlight the importance of individualized airway assessment, effective secretion management, surveillance for late complications, and continued multidisciplinary follow-up after discharge.