Assessment of the degree of agreement between the judgment of tracheotomy score and the clinician: a retrospective analysis

Abstract

Background: In oral cancer surgery, the decision to tracheotomize is often determined based on the experience of the surgeon. Sometimes, tracheotomy may be performed for cases that may not necessarily require tracheotomy. For such cases, safety is achieved by airway management, but the patients are exposed to tracheotomy-related complications. Several evaluation methods have been reported to predict the need for selective tracheotomy in patients with oral cancer. In this study, we investigated the competency of clinical scoring systems in identifying patients who require tracheotomy among the oral malignancy cases treated with surgery in our department, and examined the degree of agreement between the surgeon’s decision and the scores of various scoring systems. Methods: This study was conducted on 110 patients with oral cancer who were treated with surgery under general anesthesia in the Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, between January 2007 and April 2018. Among them, 67 patients (44 male and 23 female), who were managed by resection and reconstruction, were retrospectively analyzed. To derive the score, we evaluated the endpoint of these indices from clinical records and images. We divided the patients, based on the Cameron and Gupta scores, into two groups: tracheotomy and no tracheotomy groups, and evaluated the degree of agreement by calculating the κ coefficient. Results: After the assessment, the κ coefficients of the Gupta and Cameron scores were 0.61 (95% CI, 0.4-0.82) and 0.6 (95% CI, 0.38-0.82), respectively. The clinical evaluation of the κ coefficient indicated that the Gupta and Cameron scores agreed substantially. Discussion: These score matched the decision of the surgeon and confirmed that it was able to be applied to the decision of the airway management. However, these values are affected by prevalence. When unilateral total neck dissection and resection of the primary lesion were performed, though it was high-risk, the score was low, and an evaluation contradicted it. Conclusions: In this study, the Cameron and Gupta scores agreed with the decision of the experienced surgeon to some extent, and were confirmed to adapt to the clinical judgment.

Management of Post Tracheotomy Hemorrhage and Evaluation of Causing Factors

“…Most cases bleed immediately after surgery, but in some cases, bleeding is delayed. This result is in agreement with Allan et al Initial hemorrhages were mainly due to wound discharge, infection, aspiration trauma, ligament sliding, and bleeding / coagulation abnormalities [15][16] . While most of these patients were treated with simple measures such as proper wound care, compression with antiseptic gauze and absorbable gauze, patients with coagulopathy also required a fresh frozen plasma transfusion 17 .…”