Comparative Outcomes of Flap Maturation Versus Conventional Pediatric Tracheotomy Techniques.

Abstract

To compare postoperative outcomes of flap maturation (FMT) and conventional tracheotomy techniques in pediatric patients. A retrospective cohort study was performed using data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric database (2020-2021). Pediatric patients ≤ 18 years who underwent FMT (CPT 31610) or conventional tracheotomy (CPT 31600, 31,601) were included. Primary outcomes were 30-day reoperation, surgical site infection, pneumonia, seizures, mortality, unplanned reintubation, readmission, and length of stay. Among 2353 patients (mean age 2.9 years, 95% CI 2.7-3.1), 381 (16.2%) underwent FMT and 1972 (83.8%) underwent conventional tracheotomy. An FMT was associated with lower odds of 30-day reoperation (0.5% vs. 3.3%, p = 0.003; adjusted OR = 0.17, 95% CI 0.1-0.6, p = 0.005). Rates of surgical site infection, pneumonia, and seizures did not differ significantly between groups after adjustment. No differences were observed in mortality, reintubation, readmission, or length of stay. FMT is independently associated with lower reoperation rates without increased postoperative complications. FMT may be a favorable tracheotomy option for select patients and warrants consideration during surgical decision-making to optimize outcomes.