Comparison of 2 techniques of tracheocutaneous fistula closure: analysis of outcomes and health care use.

Abstract

Tracheocutaneous fistula (TCF) can be repaired using various techniques. This research is an outcomes and health care use comparative analysis of 2 commonly used techniques to repair TCF. To compare outcomes and health care use for 2 techniques of TCF repair. Retrospective cohort study at a tertiary care children's hospital. The study population comprised 50 consecutive patients aged 11 to 216 months who underwent surgical treatment for persistent TCF between January 2007 and August 2012. Tracheocutaneous fistula closure was achieved using excision of the TCF alone and healing by secondary intent or excision of the TCF plus primary closure over a drain. Differences in perioperative and postoperative outcomes. In total, 30 patients underwent excision of a TCF plus primary closure over a drain (closure group), and 20 patients underwent excision of a TCF alone and healing by secondary intent (excision group). Statistically, the closure and excision groups were not significantly different regarding gestational age, age at tracheotomy, duration between decannulation and TCF repair, and duration of tracheostomy. The mean (SD) procedure durations were 9.7 (3.7) minutes for the excision group and 37.4 (25.1) minutes for the closure group (P < .001). The mean (SD) lengths of hospital stay were 0.3 (0.5) day for the excision group and 1.1 (0.9) days for the closure group (P = .001). The mean (SD) lengths of intensive care unit stay were 0.0 (0.0) day for the excision group and 1.0 (1.5) day for the closure group (P = .001). Closure success rates were 20 of 22 for the excision group and 30 of 30 for the closure group (P = .17). Complication rates were 0 of 22 for the excision group and 2 of 30 for the closure group (P = .50). The rates of success and complications were not significantly different between TCF closure and excision groups. Excision of a TCF alone with healing by secondary intent requires less operating room time and shorter hospital stay, which may suggest more efficient health care use.