Association between surgical tracheostomy and chronic tracheal stenosis: a retrospective, single-center study

Abstract

Background: Tracheal stenosis is a major complication of tracheostomy. Hence, a smaller endotracheal tube (ETT) tends to be selected for patients with a prior tracheostomy history. However, it likely comes from our trial and error, not scientific evidence, because tracheal stenosis after conventional surgical tracheostomy remains relatively uncharacterized. In this study, we retrospectively examined the association between conventional surgical tracheostomy and tracheal shape as assessed by transverse computed tomography (CT).Methods: Patients who underwent surgery for head and neck cancer during the period January 2010 to December 2013, with a temporary tracheostomy closed within 3 months, were included. Exclusion criteria were tracheostoma before surgery, permanent tracheostomy, or insufficient CT follow-up. Transverse CT slices were measured 2 cm above and below the tracheostomy site (0.5 cm/slice for a total of 9 slices). The minimum cross-sectional tracheal area and horizontal and vertical diameters in transverse CT slices were compared before (baseline [BL]) and 6 months (6M) and 12 months (12M) after tracheostomy. Tracheal stenosis was defined as a decrease in the minimum cross-sectional tracheal area compared to BL.Results: Of 112 patients, 77 were included. The minimum tracheal area was significantly decreased at 6M and 12M compared to BL (BL: mean 285 [SD 68] mm2, 6M: 267 [70] mm2, P <0.01 vs. BL, 12M: 269 [68] mm2, P <0.01 vs. BL), and the localization was predominantly at or above the tracheostomy site at 6M and 12M. Tracheal stenosis was identified in 55 patients at 6M and in 49 patients at 12M without any respiratory symptoms. With regard to horizontal and vertical diameter, only horizontal diameter was significantly decreased at 6M and 12M compared to BL (BL: 16.8 [2.4] mm, 6M: 15.4 [2.7] mm, P <0.01 vs. BL, 12M: 15.6 [2.8] mm, P <0.01 vs. BL).Conclusions: Conventional surgical tracheostomy was associated with decreased horizontal diameter of the trachea (triangulation) and which resulted in decreased cross-sectional tracheal area in more than one-half of the patients without any respiratory symptoms. In patients with prior tracheostomy, regardless of the presence or absence of respiratory symptoms, use of a smaller ETT should be considered.