Trends, Outcomes, and Resource Use of Pediatric Tracheostomy in Alberta: A Cohort Study

OBJECTIVE: Medical advancements and evolving technologies have influenced pediatric tracheostomy incidence and outcomes. We examined 10-year trends in pediatric tracheostomy rates, predictors of outcomes, and resource use in Alberta, a Canadian province with a publicly funded health system. METHODS: We conducted a population-based multicenter retrospective cohort study (June 2011-May 2021) of children (<18 years) who underwent tracheostomy using data from provincial health-service databases and electronic medical records. Incidence rates were calculated from Census Canada data. Trend analyses were performed across 3 equal time periods. Outcomes included predischarge decannulation, mortality, and hospital length of stay (LOS). RESULTS: We included 279 children. The annual incidence rates fluctuated from 1.73 to 3.14 per 100 000 children, stable over time (incidence rate ratio = 1.0015; 95% CI, 0.9573-1.0477). Patients' characteristics, tracheostomy outcome, and LOS did not change over time. Risk for mortality was higher among children with underlying cardiovascular diseases (adjusted hazard ratio = 5.5; 95% CI, 1.11-27.22). Overall median (IQR) LOS was 107 days (55-212), equivalent to C$ 349 500 (167 700-730 000) acute-care cost. Children born preterm, those with cardiovascular disease, and those of Indigenous background had significantly longer LOS, with increases of 52% (Exp [β] = 1.52; 95% CI, 1.22-1.91), 170% (Exp [β] = 2.70; 95% CI, 1.56-4.69), and 147% (Exp [β] = 2.47; 95% CI, 1.69-3.62), respectively. CONCLUSIONS: Pediatric tracheostomy rates, population characteristics, and prolonged hospitalization remained stable over 10 years, underscoring substantial resource use. A higher risk of mortality in children with cardiac diseases and prolonged LOS among children who are premature and have an Indigenous background highlights the need for targeted interventions to optimize care and address disparities.