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Objectives: We investigated the long-term outcome of pediatric tracheostomy to identify predictive factors of early decannulation. Methods: We performed a retrospective chart review of a consecutive series of 75 patients less than 20 years of age who underwent tracheostomy between 1998 and 2003 during their admission in a tertiary pediatric institution. Complete information was available on 65 patients. Results: There were 41 male patients and 24 female patients (median age, 7 months). The indications for tracheostomy were an obstructed airway in 36 patients, prolonged mechanical ventilation in 15, and tracheobronchial toilet or aspiration risk in 14. Twelve patients died, and 30 of the 53 survivors were decannulated (median cannulation time, 123.5 days). Additional airway procedures were required for decannulation in those with obstructed airways. Patients who had tracheostomy performed for tracheobronchial toilet had a significantly shorter cannulation time than those with the other two indications (log-rank test, χ²(2) = 47.11; p < .00001). Patient diagnosis was also a significant predictor of cannulation time (log-rank test, χ²(2) = 66.05; p < .00001). Tracheobronchial toilet as a tracheostomy indication and both trauma and neurologic conditions as admission diagnoses were statistically significant independent variables that predicted earlier decannulation on multivariate analysis. Analysis of other group variables — age, sex, and tracheostomy insertion technique — did not reveal any significant difference in cannulation times. Conclusions: Tracheostomy indication and patient diagnosis are significant variables that predict early decannulation in pediatric patients in whom tracheostomy is required. Other variables were not shown to be significant independent predictors. [ABSTRACT FROM AUTHOR]