Tracheostomy Related Adverse Events: Is There a Weight‐Related Association in Pediatric Patients

ABSTRACT Objectives Adults have an increased risk of tracheostomy complications as body mass increases. A similar association has not been established in pediatric patients. This study assesses the relationship between weight‐for‐length percentile or body mass index (BMI) and adverse tracheostomy events in infants and children, respectively. Methods Global Tracheostomy Collaborative database was reviewed for patients < 20 years who underwent tracheostomy (2008–2023) at a tertiary center. Data collected included age, weight, height, comorbidities, tracheostomy indication, and adverse tracheostomy events. Weight‐for‐length percentile for patients < 2 years and BMI percentiles for patients ≥ 2 years were calculated. Logistic regression models assessed the association of weight‐for‐length/BMI percentiles, demographics, and comorbidities with adverse events. Results Of 474 patients (mean [SD] age, 4.1 [5.8] years), 96 (20.2%) had at least one tracheostomy adverse event. Complications included skin‐related issues 19 (19.8%), tracheostomy bleeding 17 (17.7%), suprastomal granulation tissue 17 (17.7%), accidental decannulation 14 (14.6%), and tracheostomy tube obstruction 12 (12.5%). No significant association between adverse events was identified for high versus healthy weight‐for‐length percentiles [OR = 1.22, 95% CI: 0.59, 2.53, p ‐value = 0.60], nor for high versus healthy BMI percentiles [OR = 1.43, 95% CI: 0.60, 3.37, p ‐value = 0.42]. Despite the lack of statistical significance, the adjusted odds ratio suggested a 22% increase in odds of adverse event from healthy to high weight‐for‐length classification in children under 2 years [OR = 1.22], and a 43% increased odds of adverse event from healthy to high BMI percentile for children over 2 years [OR = 1.43]. Conclusions Neither higher weight‐for‐length percentiles in infants nor increased BMI in children demonstrated a statistically significant increase of tracheostomy adverse events. The comparatively higher percentages of adverse events observed in overweight/obese children do, however, raise clinical concern and would benefit from additional larger‐scale investigations. Level of Evidence 3.