Predictors of Decannulation Success in Tracheostomy: A 10-Year Analysis of the Global Tracheostomy Collaborative Database

Objective: Decannulation is a critical milestone in functional recovery after tracheostomy, but standardized guidelines are lacking. This study examined factors associated with tracheostomy decannulation success, comparing hospital utilization, adverse events, and survival outcomes between decannulated and non-decannulated patients. Study Design: Retrospective, observational study. Setting: Data were collected from 25 hospitals participating in the Global Tracheostomy Collaborative (GTC) in the United States, Australia, and the United Kingdom. Methods: Prospectively collected data from adult patients who underwent tracheostomy from 2013 to 2022 were analyzed. Outcomes included decannulation success, hospital utilization metrics (intensive care unit [ICU] admissions, mechanical ventilation use, tracheostomy duration, and hospital length of stay), survival to discharge, discharge destinations, and adverse events. Associations were tested using t tests, chi-square, and Fine-Gray models, adjusting for clustering by site. Results: Among 5318 patients, 52.9% were decannulated before discharge. Predictors of decannulation included younger age, fewer comorbidities, elective and surgical admissions, and upper airway obstruction as an indication for tracheostomy versus facilitation of ventilation (all P <.001). Geographic variations were significant, with higher decannulation rates in Australia (82.1%) and the United Kingdom (70%) compared to the United States (13.5%) (P <.001). Decannulated patients had not only higher survival rates but also higher adverse events (11.4%, P =.002), particularly unplanned decannulation. Discharge destination varied by country, with the United Kingdom having the highest home discharge rate (P <.001). Conclusion: Decannulation success is associated with patient and institutional factors, suggesting the need for standardized protocols to promote equitable tracheostomy management. Geographic variations in decannulation rates, adverse events, and hospital utilization suggest opportunities for harmonized guidelines to enhance outcomes and resource allocation.