Tracheostomy Decannulation: Predictive Factors for Success

Clinical Publications of Interest 2026-03

This issue covers a retrospective observational study that investigates predictors for tracheostomy decannulation success. A multitude of factors influence the success of decannulation, such as the patient demographic and their geographic location, as healthcare systems vary vastly between countries. Currently, there are no standardized, global guidelines for tracheostomy care and decannulation, and previous studies investigating factors of decannulation success have focused on single-center or single-country cohorts. The current multi-center study investigates the difference in hospital utilization, decannulation success, adverse events and survival outcomes between patients who are decannulated and non-decannulated at the point of discharge. The research spanning 25 hospitals across three countries provides comparative evidence of tracheostomy decannulation success trends in adults.

Zaga CJ, Milliren CE, McGrath BA, Yang CJ, Schiff BA, Warrillow SJ, et al. Predictors of Decannulation Success in Tracheostomy: A 10-Year Analysis of the Global Tracheostomy Collaborative Database. Otolaryngol Head Neck Surg. 2025.

No standardized guidelines for tracheostomy management and decannulation

• Tracheotomy is a procedure that places a tracheostomy tube to facilitate breathing, which may be carried out in the case of upper airway obstruction, prolonged mechanical ventilation or for secretion management.
• Decannulation, the removal of the tracheostomy tube, is highly desired as having a tracheostomy in place may affect patients’ quality of life, self-esteem and psychosocial well-being.
• Currently there are no globally standardized guidelines for the initiation and practice of tracheostomy decannulation. Decannulation practices vary widely due to differences in patient populations, healthcare systems and other contextual factors.
• Practice variability may result in delayed or failed decannulations, intensive care unit (ICU) readmissions, emergency reintubation and prolonged tracheostomy care, which increases hospital staff training requirements.

Decannulated patients exhibit higher discharge survival rates

• Patients were categorized as either decannulated or non-decannulated at the point of discharge from the hospital. The decannulated population saw a 94.8% survival to discharge rate compared to the 77.9% of the non-decannulated population.
• The proportion of decannulated patients admitted to the ICU was higher than non-decannulated (97.6% and 93.6%, respectively).
• The tracheostomy duration was comparable between the decannulated and non-decannulated groups (16 and 15 days, respectively).
• Decannulated patients experienced more failed decannulations, and unplanned decannulations were more frequent than in the non-decannulated patient group.

Patient demographic - an indicator of decannulation success

• Younger age is associated with a higher likelihood of decannulation. The mean age of the entire patient group was 57.9 years, with the decannulated group having a lower mean age (56.2) than the non-decannulated group (59.8).
• Patients with a higher number of comorbidities were less likely to be decannulated. To note, statistical significance was reached only when the number of comorbidities in a patient was 5 or more compared to 0.
• Neurological comorbid systems were associated with lower success in decannulation.
• No differences in decannulation success based on sex were observed.

Characteristics of patient initial admission had a significant effect on outcomes

• Surgical admissions were significantly more prevalent in the decannulated group, while medical admissions were more prevalent with the non-decannulated population.
• Decannulation occurred more frequently in scheduled admissions compared to emergent ones.
• Decannulated patients experienced a significantly longer median hospital stay (43 days) compared to non-decannulated patients (32 days).
• The most common reason for performing a tracheotomy, for both patient groups, was the facilitation of ventilation. The facilitation of ventilation in critically ill patients was also associated with a higher anticipated mortality rate.
• Airway obstruction was the second most common reason for tracheotomy procedures in the decannulated patient population. Patients given a tracheostomy tube due to airway obstruction were more likely to be decannulated before discharge than patients who required a tracheostomy tube due to ventilation needs.

Institutional and regional practice affects outcomes in decannulation

• Between the three countries investigated, Australia had the highest proportion of decannulated patients (82.1%), while USA had the lowest (13.5%). Additionally, Australia had highest survival-to-discharge rate (89%), compared to the UK, which had the lowest (84.4%).
• The shortest median tracheostomy duration was observed in the UK (13 days), and the highest in Australia (19 days).
• The UK had the longest median hospitalization stay of 44 days, and the majority of patients (62%) were discharged to their homes. Conversely, USA had the shortest median hospitalization stay (28 days), and 40.9% of patients were discharged to long-term facilities.
• The number of discharges to homes in the UK reflects the regional differences in post-tracheostomy care. The high home discharge rates may be attributed to the increased use of hospital at home schemes, which allow patients to receive hospital-level care at home.

Key Takeaways

1. Lack of standardized, global guidelines allows for much variation in tracheostomy decannulation. Variation is seen across median hospital stays and tracheostomy durations, as well as decannulation and survival-to-discharge rates across Australia, the UK and USA.
2. Age, the number of comorbidities, the reason for admission and the length of hospital stays greatly impact patient outcomes.
3. In terms of predicting decannulation outcomes, a younger patient with no comorbidities who requires a tracheostomy due to airway obstruction and is admitted for a scheduled, surgical procedure, is a good candidate for successful decannulation.

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