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Research Snapshot Theater: Pulmonary, Pediatric I

Impact of Tracheostomy Timing on In- and Post-Hospital Outcomes

Tuesday, March 24, 2026
8:45 AM - 9:45 AM Central Time
Location: Connections Central - RST 13

  • Ryan Hessenius, M.D. (he/him/his)

    Alfred I DuPont Hospital for Children, New Jersey

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • KM

    Kimberly McMahon, MD

    Pediatric Intensivist
    Nemours Children's Hospital, Delaware

    Disclosure information not submitted.

  • KL

    Katie Labgold, PhD

    Biostatistician
    Nemours Children's Hospital Delaware

    Disclosure information not submitted.

  • Scott L. Weiss, MD, FCCM

    Nemours Childrens Hospital
    Sidney Kimmel Medical Center at Thomas Jefferson University, Pennsylvania

    Disclosure information not submitted.

  • JB

    Jenna Briddell, M.D.

    Pediatric Otolaryngologist
    Nemours Children's Hospital Delaware

    Disclosure information not submitted.

Introduction: Prior studies show early tracheostomy has beneficial effects on in-hospital outcomes for pediatric patients, but the impact of tracheostomy timing on longer-term outcomes remains unknown. We hypothesized that early tracheostomy will be associated with both improved in- and post-hospital outcomes.


Methods: We performed a single center retrospective cohort study of patients ≤21 years-old who received a tracheostomy at Nemours Children’s Hospital Delaware from 2014 to 2024. Patients admitted to the NICU, had congenital heart disease, or emergent tracheostomy were excluded. Early tracheostomy was defined as < 21 days of preceding invasive mechanical ventilation (IMV) and late tracheostomy as ≥21 days of IMV. The main in-hospital outcome was ICU LOS after tracheostomy. Post-hospital outcomes were patients undergoing decannulation at any time and change in functional status score (FSS) from time of tracheostomy through 9 months post-tracheostomy. The association of tracheostomy timing (referent = late group) with each outcome, adjusting for tracheostomy indication, were estimated using negative binomial (ICU LOS), logistic (decannulation), and linear (FSS change) regressions.


Results: Of 61 eligible patients, 37 (61%) received early and 24 (39%) received late tracheostomy. The median weight at time of tracheostomy was 20.7kg. Tracheostomy indications differed between early and late groups (p=0.02), including upper airway obstruction (30% vs 8%), neurologic process (49% vs 38%), and lung disease (22% vs 54%). The early tracheostomy group had an expected 75% shorter ICU LOS after tracheostomy than late tracheostomy (adjusted incidence rate ratio = 0.25, 95% confidence interval (CI): [0.14, 0.44], p= < 0.001). . There was no difference between the early and late tracheostomy groups in the odds of undergoing decannulation (adjusted odds ratio=0.92, 95% CI: [0.29, 2.9], p=0.88) and average difference in FSS change (adjusted β =0.73, 95% CI: [-2.2, 3.7], p=0.62).


Conclusions: Children who underwent early tracheostomy had a shorter expected ICU LOS after tracheostomy compared to those who underwent late tracheostomy, but post-hospital outcomes were not different between groups. Additional work is warranted to further investigate timing of tracheostomy and its association with post-hospital outcomes.