Immediate Postoperative Complications in Adult Tracheostomy

Abstract

Objective Tracheostomy is one of the oldest operations for the management of airway obstruction. With time, indications expanded to prolonged mechanical ventilation, and currently, the majority of tracheostomies are done for this reason. There are several techniques used in a tracheostomy procedure, depending on surgeon preference. Immediate complications such as bleeding, pneumothorax, pneumomediastinum, airway fire, and posterior tracheal wall perforation with esophageal injury are rare, although they do occur, and must be managed accordingly. This study aimed to assess differences in types and rates of immediate postoperative complications in patients undergoing tracheostomy when performed under general anesthesia and local anesthesia (awake tracheostomies) at a large academic institution. This is a continuing ongoing literature reporting tracheostomy adverse events. Methods A retrospective chart review was performed to identify patients who underwent tracheostomy placement between January 1, 2013 and December 31, 2019 at the Detroit Medical Center, USA. Postoperative complications such as bleeding, pneumothorax, pneumomediastinum, airway fire, and posterior tracheal perforation were collected along with gender, age, and revision tracheostomy status. IBM SPSS Statistics (IBM Inc., Armonk, USA) was used for statistical analysis with the statical significance defined as a p<0.05. Results A total of 1,469 patient charts were reviewed. Of these, 1,342 met the inclusion and exclusion criteria, of which, males were 57.2% (n=768), and females were 42.8% (n=574). The age range was 18 years to 96 years (mean=58.03; SD= 15.97), and BMI range was 12-83 (mean=28.77; SD=7.885). Multinomial logistic regression was performed to determine whether age, BMI, sex, and revision tracheostomies were represented across both general and awake tracheostomy groups proportionally to their numbers in the total sample. It showed non-significant value for age (χ2=0.776, p=0.378), BMI (χ2=0.004, p=0.947), but significant value for sex (χ2=4.645, p=0.031), revision tracheostomy (χ2=18.282, p<0.001), indicating that males and revision tracheostomies over-represented in awake tracheostomies. Next, Pearson correlation analysis was performed to determine any significant linear relationship between age, sex, and tracheostomy complications. It showed a significant positive correlation between age and tracheal stomal infection [r(1,340)=0.062, p=0.022]. An independent sample t-test showed a statistically significant difference between the mean pneumothorax and pneumomediastinum of general (n=1,277, mean=0.01, SD=0.088) and awake tracheostomies (n=65, mean=0.08, SD=0.269, t=2.069, p=0.043). Pneumothorax pneumomediastinum complications between the general tracheostomy and awake tracheostomy odds ratio (OR)-6.22, indicates the chance of pneumothorax /pneumomediastinum complication is 6.22 times more in awake tracheostomy than general tracheostomy. ...

Safety of surgical tracheostomy under continued antithrombotic therapy: A retrospective cohort study

“…Based on the present results, we recommend that surgeons should pay careful attention to complications during ST under local anaesthesia and in airway emergencies. Awake tracheostomy is 6.2 times more likely to result in pneumothorax or pneumomediastinum than general tracheostomy 5 …”

“…Awake tracheostomy is 6.2 times more likely to result in pneumothorax or pneumomediastinum than general tracheostomy. 5 Patients undergoing awake tracheostomy often breathe spontaneously after tracheostomy and are prone to the cough reflex due to the presence of a tracheal cannula, which may result in subcutaneous emphysema. Particularly, in airway emergencies, the risk of subcutaneous emphysema may have been increased because securing the airway is a top priority, despite the consideration of safety.…”

“…1,2 Postoperative complications of ST are rare, and the early and late postoperative complication rates are 5.6% and 7.1%, respectively. 3 Obesity and awake tracheostomy are major risk factors for postoperative complications of ST. 4,5 Furthermore, four or more comorbidities are reported to increase the risk of postoperative bleeding, which is the most frequent early complication of ST. 3,6 Additionally, ST is sometimes necessary for patients undergoing continued antithrombotic therapy (CAT), which can exacerbate the risk of bleeding.…”

Percutaneous ultrasound-guided versus bronchoscopy-guided dilatational tracheostomy after median sternotomy: A case-control study

“…One of the most important complications of PDT is posterior wall perforation with esophageal injury. [ 16 ] Although rare in experienced hands, bronchoscopy guidance is the gold standard to avoid this complication. Balaban et al[ 17 ] reported in their case series that they successfully completed the PDT procedure under US guidance and accompanied by bronchoscopy in three patients, one of whom was operated for aortic dissection, one patient with trauma and one with hypoxic encephalopathy.…”

Safety of surgical tracheostomy under continued antithrombotic therapy

“…1,2 Postoperative complications of ST are rare, and the early and late postoperative complication rates are 5.6% and 7.1%, respectively. 3 Obesity and awake tracheostomy are major risk factors for postoperative complications of ST. 4,5 Further, four or more comorbidities are reported to increase the risk of postoperative bleeding, which is the most frequent early complication of ST. 3,6 Additionally, ST is sometimes necessary for patients undergoing continued antithrombotic therapy (CAT), which can exacerbate the risk of bleeding. However, there is a dearth of data regarding ST under CAT.…”