Predictors of Complications Occurrence Associated With Emergency Surgical Tracheotomy

Abstract

Objective In emergency airway management, the occurrence of surgical tracheotomy complications is increased and may be fatal for the patient. However, the factors that play a role in complication occurrence and lead to lethal outcome are not known. The objective of this study was to determine predictors associated with the occurrence of complications and mortality after emergency surgical tracheostomy. Study Design Retrospective study with a systematic review of the literature. Setting Tertiary medical academic center. Subjects and Methods We included 402 adult patients who underwent emergency surgical tracheostomy under local anesthesia due to upper airway obstruction. Demographic, clinical, complication occurrence, and mortality data were collected. For statistical analysis, univariable and multivariable logistic regression methods were used. Results In multivariable analysis, significant positive predictors of complication occurrence were previously performed tracheotomy (odds ratio [OR] 3.67, 95% confidence interval [CI], 0.75–17.88), neck pathology (OR 2.05, 95% CI 1.1–1.77), and tracheotomy performed outside the operating room (OR 5.88, 95% CI, 1.58–20). General in-hospital mortality was 4%, but lethal outcome as a direct result of tracheotomy complications occurred in only 4 patients (1%) because of intraoperative and postoperative complications. Conclusion The existence of neck pathology and situations in which tracheotomy was performed outside the operating room in uncontrolled conditions were significant prognostic factors for complication occurrence. Tracheotomy-related mortality was greater in patients with intraoperative and early postoperative complications. Clinicians should be aware of the increased risk in specific cases, to prepare, prevent, or manage unwanted outcomes in further treatment and care.

Tracheotomy During Pandemic COVID-19 Outbreak. Experience At University Clinical Center Tuzla

“…There was a significantly important correlation of the presence of pathogenic microorganisms and tracheostoma infection (p=0.00) determined for the whole sample, and after a subsequent testing, it was determined that this correlation results from statistically significant correlation of the presence of pathogenic microorganisms and the infection of tracheostoma only in group A patients. The rate of individual complications in our study was between 3.9% to 25% which does not differ significantly from the published figures in the literature ranging from 5.6% to 27.2% (35)(36)(37)(38)(39)(40). The incidence of overall tracheotomy complications in COVID-19 patients is higher than in the general population.…”

Efficacy and Safety of Tacrolimus Therapy for a Single Chinese Cohort With Very-Late-Onset Myasthenia Gravis

“…For the two dying of MG crisis in the control group, there seemed no direct associations with medications regarding the normal therapies they received. Failure to quickly identify the impending respiratory paralysis and complex comorbid conditions could explain the death of an outbreak at home; the other patient died from tracheotomy-related death together with MG crisis, unresponsive wakefulness syndrome, and pneumonia, all being hazard factors for tracheotomy complications ( 38 ). We need to focus more on the prevention of myasthenia crisis, which is typically precipitated by poor control of generalized MG.…”

Emergency surgical tracheotomy in the era of COVID-19 pandemic

“…However, this should be balanced by the associated risks. Jotic et al identified several predictors of perioperative morbidity and mortality in patients undergoing emergency OST [42]. Attention must be paid in the case of patients that previously underwent tracheotomy or neck radiotherapy, or in those with pathologies of the neck.…”

“…Despite the higher incidence of perioperative complications of OST procedure performed in non-operating theatre context [42], most authors recommend avoiding the transport of patients between different hospital services because of the high risk of viral contamination. In those cases in which the patient's transfer appears unavoidable, reserved routes should be used.…”