Analysis of 255 tracheostomies in an otorhinolaryngology-head and neck surgery tertiary care center: a safe procedure with a wide spectrum of indications

Abstract

Purpose To review indications, patient characteristics, frequency, and safety for surgical tracheostomies performed by otolaryngologist-head and neck surgeons in a single tertiary care center. Methods Surgical tracheostomies performed by otolaryngologist-head and neck surgeons at Helsinki University Hospital between January 2014 and February 2017 were retrospectively reviewed. Patient demographics, surgical data, and peri- and postoperative mortality information were collected from the hospital charts. Minimum follow-up was 18 months. Results The total population was 255, with a majority ( n = 181; 71%) of males. The majority of patients ( n = 178; 70%) were classified as ASA 3 or 4. A total of 198 (78%) patients suffered from head and neck cancer. Multiple (14 altogether) indications for tracheostomy were identified, and simultaneous major head and neck tumor surgery was common (in 58%). Altogether, 163 (64%) patients were decannulated during follow-up with a median cannulation period of 9 days (range 1–425). The surgical mortality was 0.4%. Conclusion Simultaneously performed major tumor surgery was the most common indication for a tracheostomy. A notable number of patients had impaired physical status, but relatively insignificant comorbidities. Almost two-thirds of the patients were decannulated during follow-up, although some patients remained tracheostomy dependent for a prolonged period. Tracheostomy was found to be a safe procedure. Level of evidence 2b.

Comparison of intubation and tracheotomy in adult patients with acute epiglottitis or supraglottitis

“…The late complications after airway management in AE or AS need evaluation in future studies, as known late complications of tracheotomy and intubation include for example tracheal stenosis [17, 18] and tracheocutaneous fistula after tracheotomy [19], and laryngeal granulomas and arytenoid cartilage dislocation after intubation [20, 21]. Our recent study reported surgical mortality to be 0.4% in all tracheotomized patients ( n = 255) in our department, with AE or AS comprising only seven of indications for the procedure [22].…”

Early postoperative complications following tracheotomy: Does suturing technique influence outcomes?

“…We noted that the most common indication for tracheotomy was simultaneous surgery for head and neck cancer (50.5%), which is comparable to studies evaluating surgical tracheostomies performed specifically by otolaryngologists reporting 57.6% and 45%. 3 , 21 Though these patients comprised the largest subset of our population, it should be noted that this cohort is a markedly heterogeneous population with all the implications that entails. The effects of the heterogeneity of this population can be seen in the ED readmission rates reported.…”

“…1 Complications with higher mortality rates in the intra-operative and early postoperative period include pneumothorax, hemorrhage, accidental decannulation and false passage, mucus plug, whereas, pneumonia and infections are typically less severe. [1][2][3][4] Late postoperative complications include subglottic stenosis, tracheal stenosis, tracheocutaneous fistula, tracheoesophageal fistula, tracheoinnominate artery fistula, accidental decannulation, and infection. [4][5][6][7] Studies have reported that complications occur in 5%-40% of tracheostomies, but the vast majority are minor.…”

European white paper: oropharyngeal dysphagia in head and neck cancer

“…Besides the risk of bleeding and infection, which comprises both pneumonia or wound infection, other adverse events have been reported. These include secondary sinusitis, pneumothorax, subcutaneous emphysema, and persistent damage of the tracheal cartilage [ 77 ]. The one-year overall survival after tracheotomy in a mixed population in need for airway assistance (both neurological intensive care unit and HNC population) was 50% [ 78 ].…”