Time to decannulation failure among patients undergone tracheostomy in Rwanda. Survival Analysis

Abstract

Background Tracheostomy is essential for patients needing 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). Methodology: This was a cross-sectional study, data on 62 patients who underwent tracheostomy at CHUK from October 2022 to September 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. Results Decannulation failure observed from 22 patients (36.7%). The median time to decannulation was 60 days. KM indicated less decannulation median times for emergency tracheostomies (60 days) compared to elective ones (68 days) and less for females (60 days) Compared to males (68 days). Elective tracheostomy significantly improved decannulation success, with an Adjusted Hazard Ration (AHR) of 0.19 (95% CI:0.04–0.91, P = 0.039) indicating lower hazard for decannulation failure compared to emergency type. Age of a patient increased with less hazard to decannulation failure, however, the association was not statistically significant. Conclusion Decannulation times at CHUK are influenced significantly by the nature of the tracheostomy, with elective procedures faring better. There is a need for strategic planning in the timing and management of tracheostomies to enhance patient outcomes.