The Impact of Follow-Up Care on Tracheostomy Management Post-Hospital Discharge: A Longitudinal Cohort Study of Clinical Outcomes, Quality of Life, and Long-Term Recovery.

Background: Tracheostomy is a life-saving procedure associated with complex long-term care needs and potential complications, including stoma infections, respiratory challenges, and impaired quality of life (QoL). While follow-up care is widely recommended, its impact on adherence to maintenance practices, clinical outcomes, and long-term recovery has not been thoroughly evaluated. Objectives: This study examined the influence of follow-up care on tracheostomy management, adherence to care routines, clinical outcomes, and QoL three months and three-years post-discharge. Key objectives included assessing adherence to stoma cleaning and tube changes, evaluating complication rates, tracheostomy retention, and analyzing QoL outcomes in patients who received follow-up care compared to those who did not. Methods: A longitudinal cohort study was conducted at The Johns Hopkins Hospital, including 220 adult patients who underwent tracheostomy between 2007 and 2017. Data were collected through electronic health records and structured telephone surveys. Primary outcomes included adherence to maintenance practices, clinical complications, and health-related quality of life (HRQoL) measured using the SF-8 Health Survey. Statistical analyses included chi-square tests, t-tests, and multivariate regression. Results: Among 220 patients who completed the study, 166 (75.5%) received follow-up care. Patients with follow-up care demonstrated significantly higher adherence to stoma cleaning protocols (p = 0.001), although tube change frequency did not differ between groups (p = 0.37). Follow-up care was associated with more frequent identification of complications, including stoma infections (7.8% vs. 1.9%, p = 0.11) and respiratory difficulties (39.1% vs. 22.2%, p = 0.05). However, these differences were not statistically significant except for breathing difficulties. HRQoL analyses revealed marginally lower physical component scores (PCS) in the follow-up group (44.4 vs. 48.0, p = 0.03), while mental component scores (MCS) were comparable between groups (42.1 vs. 42.8, p = 0.66). At three years post-discharge, tracheostomy tube retention was low (6.8%), with stenosis being the most common reason for long-term tracheostomy dependence. Follow-up care was associated with a higher likelihood of timely tracheostomy tube removal and improved cosmetic outcomes. Conclusions: Follow-up care plays a critical role in improving adherence to tracheostomy maintenance and ensuring timely management of complications. However, disparities in QoL outcomes and care protocols highlight the need for standardized, multidisciplinary follow-up systems. Future research should explore scalable interventions, such as telehealth, to optimize care for tracheostomy patients and address barriers to equitable access.