Survival analysis of time to decannulation and failure drivers among tracheostomy patients in Rwanda.

Abstract

Background: Tracheostomy is essential for patients requiring prolonged ventilation, but studies on decannulation in Sub-Saharan Africa, including Rwanda, are limited. This study assesses decannulation success rates and identifying factors influencing the outcomes at the University Teaching Hospital of Kigali(CHUK).

Methods: This was a retrospective cross-sectional study. Data on 62 patients who underwent tracheostomy at CHUK from October 2022 to October 2023 and reached decannulation were analyzed. Survival analysis was conducted using R, employing Kaplan-Meier (KM) curves to estimate median time to decannulation and Cox proportional hazards models to determine factors affecting outcomes. Bboth adjusted hazard ratio (AHR) and their confidence intervals (CI) were reported.

Results: Decannulation failure observed from 22 patients (35.5%). The median time to decannulation was 60 days (Interquartile range (IQR): 46-74). KM indicated a shorter decannulation median time for elective tracheostomies (60 days, IQR: 43-77) compared to emergency ones (180 days, IQR: 151-209) and for females (60 days, IQR: 49-71) Compared to males (68 days, IQR:52-84). Elective tracheostomy was significantly associated with decannulation success, with an adjusted hazard ratio (AHR) of 0.19 (95% CI: 0.04-0.91, P = 0.039), indicating lower hazard for decannulation failure compared to emergency type. However, this finding is exploratory and should be interpreted cautiously. Age of a patient increased with less hazard to decannulation failure; however, the association was not statistically significant.

Conclusions: Male Patients and those undergoing elective tracheostomies had a longer median time to decannulation. The findings highlight the importance of strategic planning in determining the timing and type of tracheostomy, with a focus on optimizing conditions for elective procedures whenever possible to improve patient outcomes.