Social impact of paediatric tracheostomy: our experiences at a tertiary care teaching hospital

Introduction
Paediatric patients may require tracheostomy in certain clinical conditions with upper airway obstruction or in critical conditions requiring prolonged ventilation. It is often associated with higher rates of morbidity along with social stigma if it is sustained for a longer period. Although there are several studies available in medical literature for indications, complications, and different techniques for tracheostomy, but most of them do not provide any insight into the social impact of tracheostomy. The aim of this study is to assess the social impact of tracheostomy at a tertiary care teaching hospital.

Material and methods
This is a retrospective observational study done at a tertiary care teaching hospital. The study was carried out from December 2017 to January 2020. Twenty-four paediatric tracheostomy patients participated in this study. The observed complications in tracheostomy such as surgical/medical and social issues were documented. We conducted structured interviews with caregivers of patients with tracheostomy.

Results
Medical or surgical complications included excess mucus production (70.83%), infections at the stoma site (33.33%), blockage (25%), granulations around the stoma (16.66%), and maggots at the stoma (4.16%). The social impacts on tracheostomy patients included family reluctance to accept the patient with a tracheostomy tube, inability to communicate, and problems with social integration.

Conclusions
Tracheostomy has several ranges of effects on the quality of life of caregivers and patients with tracheostomy. Management of social stigma associated with permanent tracheostomy is more challenging than any complications due to the tracheostomy procedure itself. It can be solved with proper counselling with family members and those involved with patients.