Is open tracheotomy performed by residents in otorhinolaryngology a safe procedure? a retrospective cohort study

Fiorini, Francesca Romana; Santoro, Roberto; Deganello, Alberto; Mannelli, Giuditta; Meccariello, Giuseppe; Gallo, Oreste

doi:10.1007/s00405-014-3074-7

Cited by 12 publications

(10 citation statements)

References 22 publications

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“…Previous studies have reported mixed results regarding the impact of involving trainee surgeons, in a variety of surgical specialties. 7–15,19–24 There have been relatively limited studies in otolaryngology, 1,15–17 especially on the impact of specific procedures. A thorough literature review revealed that the impact of resident participation has only been investigated in open tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

Safety of tympanoplasty and ossiculoplasty performed by otorhinolaryngology trainees

et al. 2020

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ObjectiveThis study aimed to examine the impact of trainee involvement in performing tympanoplasty or tympano-ossiculoplasty on outcomes.MethodsA retrospective analysis was performed of a prospective database of all patients undergoing tympanoplasty and tympano-ossiculoplasty in a single centre during a three-year period. Patients were divided into three primary surgeon groups: consultants, fellows and residents. The outcomes of operative time, surgical complications, length of hospital stay, and air–bone gap improvement were compared among the groups.ResultsThe study included 398 tympanoplasty and tympano-ossiculoplasty surgical procedures, 71 per cent of which were performed by junior trainees (residents). The junior trainee group was associated with a significantly longer surgical time, without adverse impact on outcomes.ConclusionTrainee participation in tympanoplasty and tympano-ossiculoplasty surgery was associated with longer surgical time, but did not negatively affect the peri-operative course or hearing outcome. Therefore, resident involvement in these types of surgery is safe.

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Section: Discussionmentioning

confidence: 99%

Safety of tympanoplasty and ossiculoplasty performed by otorhinolaryngology trainees

et al. 2020

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“…When it comes to OST, which is among the initial surgical procedures trained in otolaryngology residency, there is only one study evaluating the safety in terms of performer. 10 In that study, Fiorini et al Compare the overall complication rates between supervised residents and surgeons. But the study groups were not homogenous, namely they did not exclude emergency cases and cases with malignancy of upper aero-digestive tract which might led bias.…”

Section: Discussionmentioning

confidence: 99%

“… 11 Fiorini et al also categorise them as perioperative, early and late. 10 In the current study, complications were not categorized according to time of procedure. Because, to make an inference about safety, one should consider eventual complication rates rather than relying on timeline.…”

Section: Discussionmentioning

confidence: 99%

“…In this study Fiorini et al Compare overall complication rates without classifying them into minor and major and they found no higher overall complication rate in OSTs performed by residents. 10 We aimed to find out if there is any difference between OSTs performed by supervised residents and attending surgeons in terms of minor and major complication rates, which is not studied before. We also evaluated the effect of Reason for Hospitalization (RfH) on complication rates.…”

Section: Introductionmentioning

confidence: 99%

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The Safety of Open Surgical Tracheotomy Performed by Otorhinolaryngology Residents

2018

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Objective:We aimed to clarify the safety of open surgical tracheotomy performed by supervised residents, and the impact of “reason for hospitalization” on complication rates in open surgical tracheotomy technique.Methods:In this retrospective cohort study, the medical files and documents of 277 patients who underwent open surgical tracheotomy (OST) over a period of 12 years from October 2005 to July 2017 were analyzed. Forty four patients were excluded due to emergent tracheotomy and presence of malignancy. Remaining 223 cases were divided into two groups as “OSTs done by supervised residents” and “OSTs done by attending surgeons”. Age, gender, reason for hospitalization, observation time and complications were noted. The overall minor and major complication rates and each complication rate were compared with regard to the operating surgeons.Results:No statistically significant difference between two groups was demonstrated in terms of observation time (p=0.127). Minor complication rate for residents and attending surgeons was 14.7% and 17.5%, whereas major complication rate was 6.3% and 5.0%, respectively. No significant difference was found between two groups both in terms of minor (p=0.58) and major (p=0.43) complication rates. No risk of “reason for hospitalization” on minor and major complications was found (p=0.06, p=0.15).Conclusion:Open surgical tracheotomy performed by supervised residents is as safer as the ones performed by the attending surgeons. The study also showed that “reason for hospitalization” does not potentiate the occurrence of tracheotomy related complications.

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“…First described in 1909, ST may result in several life-threatening complications, including tension pneumothorax, subcutaneous emphysema, and arterial-tracheal fistula [ 2 – 4 ]. Tracheal ring fracture has been noted to occur during open tracheostomy, though this occurrence is rare [ 5 ]. Tracheal stenosis as early as 15 days has been reported following ST [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Case Report of Multiple Tracheostomy Revisions due to Persistent, Recurrent Cuff Leak

Azimi-Bolourian¹,

Hanna²,

Williams³

2015

Case Reports in Anesthesiology

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This case is a patient with amyotrophic lateral sclerosis who was unable to be separated from mechanical ventilator support and required a tracheostomy. The patient underwent an initial open tracheostomy utilizing flexible fiberoptic tracheoscopy (FFT) in the operating room (OR). Subsequently, he developed recurrent leaks in the tracheal tube cuff requiring multiple trips back to the operating room. The recurrent cuff leak occurred following each tube placement until the etiology of the leak was discovered during the fourth procedure. In the fourth procedure, the wound was explored more extensively, and it was found that there was a sharp, calcified, aberrant fragment of a tracheal cartilage ring protruding into the tracheal lumen, which was damaging the cuff of each tube. This fragment was not visible by multiple FFTs, nor was it visible in the wound by the surgeons until wider exploration of the wound occurred. The cartilage fragment was ultimately excised and the patient had no further cuff leaks. Aberrant tracheal cartilage should be on the differential diagnosis for cuff leaks subsequent to surgical tracheostomy (ST) or percutaneous dilatational tracheostomy (PDT).

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Is open tracheotomy performed by residents in otorhinolaryngology a safe procedure? a retrospective cohort study

Abstract: be disheartened. Our study demonstrates that it is safe and does not lead to higher risk of complications nor negatively affects the quality of care.

Cited by 12 publications

References 22 publications

Safety of tympanoplasty and ossiculoplasty performed by otorhinolaryngology trainees

Safety of tympanoplasty and ossiculoplasty performed by otorhinolaryngology trainees

The Safety of Open Surgical Tracheotomy Performed by Otorhinolaryngology Residents

Case Report of Multiple Tracheostomy Revisions due to Persistent, Recurrent Cuff Leak

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