Adults with laryngotracheal stenosis who missed clinic appointments took longer to reach decannulation, the point at which they were no longer tracheostomy dependent, according to a retrospective study of 60 patients who underwent airway surgery. Each no-show or late cancellation was associated with a 25% longer time to decannulation. The reported time ratio was 1.25, with a 95% confidence interval of 1.07 to 1.45 and a p-value of 0.004.
The study also found a marked difference in follow-up between patients who were eventually decannulated and those who remained dependent on a tracheostomy. At least two scheduled visits were missed by 38.5% of the non-decannulated group, compared with 8.5% of the decannulated group. Seven patients in the non-decannulated group, or 53.8%, were lost to follow-up. The total number of clinic visits did not differ significantly between the groups.
What the study found
Overall, 47 of the 60 patients, or 78.3%, achieved decannulation. The participants had tracheostomy dependence related to laryngotracheal stenosis, wanted to be decannulated and had undergone surgery intended to restore airway patency. Patients were excluded if they did not want decannulation, if decannulation was considered unsafe or inadvisable, or if they depended on a ventilator.
The investigators had expected greater psychosocial vulnerability and poorer care engagement to be linked with lower decannulation rates. Prior psychiatric diagnoses were more common among patients who were not decannulated, at 53.8% compared with 29.8%. Multiple psychiatric diagnoses were recorded in 38.5% of the non-decannulated group and 14.9% of the decannulated group. But the overall psychiatric difference was not statistically significant, and substance-use diagnoses also did not differ significantly.
In the analysis of time to decannulation, a prior psychiatric diagnosis was associated with a reported 72% longer time. That estimate was not statistically significant, however. Its time ratio was 1.72, with a 95% confidence interval from 0.92 to 3.21 and a p-value of 0.091.
Other differences were less certain
The researchers reported no significant differences in decannulation status by age, sex, race, body mass index, other medical conditions, the reason for the tracheostomy, or the characteristics of the airway narrowing.
Emergency-department visits and routine tracheostomy complications were not significantly associated with whether patients were decannulated. Three or more emergency-department visits occurred in 38.5% of non-decannulated patients and 14.9% of decannulated patients, but the difference was not statistically significant. Tube dislodgement was also more frequent among patients who were not decannulated, at 69.2% versus 38.3%, although that result did not reach statistical significance.
Distance from the hospital and social vulnerability showed little difference between the groups. The mean distance was 116.1 miles for patients who were not decannulated and 92.0 miles for those who were, while the share in the highest social vulnerability quartile, with scores from 0.75 to 1.00, was 69.2% and 66.0%, respectively. Neither comparison was statistically significant.
A signal, not a cause
The findings show an association, not proof that missed appointments delay decannulation or cause patients to remain tracheostomy dependent. The study was a retrospective review of electronic medical records from one academic tertiary-care center, covering adults treated between September 2021 and November 2025. The investigators collected demographic, clinical, psychiatric, substance-use, social-vulnerability, tracheostomy, surgical and follow-up information from those records.
The cohort was small, and the groups were uneven, limiting the study's statistical power, particularly for psychiatric and substance-use comparisons. The time analysis used separately adjusted log-logistic accelerated failure time models, rather than one unified multivariable model. That limited the researchers' ability to control for confounding factors that might be related both to appointment attendance and to decannulation.
The narrowly defined, single-center cohort also does not establish that the findings apply to people who depend on ventilators, did not want decannulation, receive care in community settings or belong to other tracheostomy populations. The study did not test follow-up, care-navigation, mental-health or substance-use interventions, so it cannot show that changing appointment adherence would improve decannulation rates or shorten the time to tube removal.
Disclosures
The authors reported no funding information, declared no conflicts of interest and said that study data are available from the corresponding author upon reasonable request.
Paper data and sources
Original title: Association of Care Engagement and Psychosocial Factors With Tracheostomy Decannulation.
Authors: Cyrus W Abrahamson, Abbey L Landini, Maya Frost et al.
Journal/Repository: Laryngoscope investigative otolaryngology
Status: Peer-reviewed
First online: 2026-08-20
DOI: 10.1002/lio2.70543
Original paper