Replacing tracheostomy with overnight intubation to manage the airway in head and neck oncology patients: towards an improved recovery

Tracheostomy and infection prolong length of stay in hospital after surgery for head and neck cancer: a population based study

“…7,8,14 LOS was also longer in Ireland compared with that observed in specialist centers in the United Kingdom. 15,16 LOS in Ireland was similar to that observed in 2 specialist center studies from France. 17,18 Relative to the United States, longer LOS in Ireland may reflect U.S. insurers exercising greater control of LOS than was the case in public hospitals in Ireland.…”

“…27 Tracheostomy has been reported to increase the risk of chest infection after HNC surgery. 15,28,29 Some advocate intubation over tracheostomy as a safer option, 15 whereas some others see tracheostomy as being essentially eventfree, except where neoadjuvant radiotherapy is adminstered. 30 Our data show that tracheostomy was frequently used after more extensive procedures to secure the airway, as might be expected.…”

Limited dissection and early primary closure of the tracheostomy stoma in head and neck oncology operations: a retrospective study of 158 cases

“…These results are in line with those of a recent study by Coyle et al performed in 2013 that also showed no long-term complications associated with tracheostomies. 11 Coyle et al suggested that tracheostomies should not be used as a routine procedure if a less invasive alternative is possible, e.g., overnight intubation, since the use of tracheostomies in their study prolonged the hospital stay and therefore costs. Although a tracheostomy is a relatively safe procedure, we also believe that its use should be limited to cases where there is a significant risk to the airway and if extubation may not be possible for the first 3 days postoperatively.…”

Tracheostomy or delayed extubation after maxillofacial free-flap reconstruction?

“…[2][3][4][5][6] We know of no universally accepted algorithm or scoring system to help clinicians choose the most appropriate method of managing the airway, 7,8 but reported evidence suggests that patients who do not have a tracheostomy recover faster and have a shorter stay in hospital than those who do. 5,[9][10][11] Restricting the use of tracheostomy to selected cases has also become an important part of some ERAS (enhanced recovery after surgery) programmes. 12 patients who have had a tracheostomy and those who have not because of the diverse range of coexisting conditions and the different operations.…”

“…12 patients who have had a tracheostomy and those who have not because of the diverse range of coexisting conditions and the different operations. 10,13 At the Oral and Maxillofacial Surgery (OMFS) Unit at St George's Hospital, London, UK, tracheostomy is done only in selected patients who have free-flap reconstruction. We retrospectively audited the postoperative management of the airway (tracheostomy or delayed extubation) in these patients, and reviewed the cases that required a secondary or delayed tracheostomy, and those with serious complications related to the procedure.…”