Tracheostomy after paediatric cardiac surgery: a marker of postoperative complexity and clinical outcomes

Abstract Background: Tracheostomy is infrequently required after paediatric cardiac surgery and is generally considered for patients with prolonged mechanical ventilation or recurrent extubation failure. This study aimed to identify factors associated with the need for tracheostomy and to evaluate clinical outcomes among these patients. Methods: We retrospectively reviewed 1,840 paediatric patients who underwent cardiac surgery at a single centre between 2019 and 2025. Demographic, perioperative, and postoperative factors associated with the need for tracheostomy, as well as outcomes among patients who underwent tracheostomy, were evaluated. Results: Tracheostomy was performed in 34 patients (1.8%). The median age was 8 months, and 22 patients (64.7%) were younger than 1 year. Tracheostomy was performed at a median of 28.5 days after surgery, and the median total duration of mechanical ventilation during hospitalisation was 65 days. Age < 1 year was independently associated with the need for tracheostomy (odds ratio, 2.59; 95% confidence interval, 1.26–5.35; p = 0.010). Haemofiltration was also associated with tracheostomy (odds ratio, 3.94; 95% confidence interval, 1.84–8.44; p < 0.001), likely reflecting greater postoperative disease severity. Overall mortality was 20.6% (7/34), with no deaths related to tracheostomy. Among the 27 survivors, 24 (88.9%) underwent decannulation at a median of 62 days after tracheostomy. Two survivors were discharged with home mechanical ventilation, and one was discharged with a tracheostomy in place. Conclusions: Tracheostomy was uncommon after paediatric cardiac surgery and was primarily used in patients with prolonged and complex postoperative recovery. The need for tracheostomy appeared to reflect both patient‑related factors and greater postoperative complexity.