National changes in pediatric tracheotomy epidemiology during 36 years

Abstract

Background

Information on the incidence, indications and morbidity of pediatric tracheotomy from a nationwide setting is sparse.

Methods

From the nationwide Danish National Patient Registry, we identified all cases: 0–15-year-old children registered with a first-time tracheotomy from 1979 to 2014. We extracted the date of surgery, admission, discharge, age, gender, hospital, department, hospitalization length, hospital contacts, and diagnosis-code related to the surgery. We estimated age-adjusted incidence rates (AAIR) and annual (APC) and average annual percentage change (AAPC) of tracheotomy incidence.

Results

A total of 510 children (328 boys, 63%) underwent tracheotomy. The median age at surgery was 8 years. The AAIR was 1.4/100,000 person-years (range 1.0–1.8) from 1980 to 2014. During 1979–2014, the AAPC decreased − 0.9% (95% confidential interval – 2.4; 0.8, p < 0.3). From 1979 to 2003 the APC decreased − 4.1% (95% CI − 5.4; − 2.8, p < 0.001) and from 2003 to 2014 the APC increased 6.6% (95% CI 2.0; 11.5, p < 0.001). Infants had the highest incidence (4.0/100,000 years) compared with the 12–15-year-olds (AAIR: 0.4/100,000 years). From 1979 to 2014 the most common indication for tracheotomy among children aged 0–2 years was congenital malformations (n = 48, 30%) and among children aged 3–11 and 12–15 years the most common indication was trauma (respectively n = 67, 36% and n = 85, 52%). During 2006–2014 the most common indications for all ages was neurological impairment (n = 25, 21%) and neoplasms (n = 20, 17%).

Conclusions

Pediatric tracheotomy was a rare surgical procedure with decreasing incidence rates from 1980–89 to 1990–99 and increasing incidence rates from 2000–2009 to 2010–2014. Indications and postoperative morbidity have changed adjunct to the treatment of chronic disorders.

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