Retrospective analysis of open bedside tracheotomies in a German tertiary care university hospital

• Published in: Journal of cranio-maxillo-facial surgery 2021-02, Vol.49 (2), p.140-145
• Main Authors: Riekert, Maximilian, Kreppel, Matthias, Schminke, Philipp, Weckx, Annelies, Zöller, Joachim E., Schick, Volker C.
• Format: Article
• Language: English
• Subjects: Airway; Complications; Dentistry; Hospitals; Humans; Postoperative Complications - epidemiology; Retrospective Studies; Squamous cell carcinoma; Tertiary Healthcare; Tracheotomy; Tracheotomy - adverse effects
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2020.12.010

Open surgical tracheotomy performed beside (STB) is a standardized procedure in critical ill patients. The aim of the study was to evaluate perioperative complications and the safety of STB in a tertiary care university hospital setting. Intra- and postoperative complications were retrospectively recorded and associations based on the evaluation of clinical and laboratory parameters were studied using regression analyses. A total of 562 patients were included. Early tracheotomy shortened ventilation time after tracheotomy (ventilation before STB ≤ 5 days: mean 9.2 ± 9.1 days; ventilation before STB ≥ 6 days: mean 11.5 ± 10.5 days, p = 0.0001). Overall complications were found in 30/562 cases (5.3%), major complications in 12/562 cases (2.1%). Significant risk factors for overall tracheotomy related complications were higher body mass index (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.01–1.07, p = 0.02), lower CRP (OR 0.99, CI 0.99–1.00, p = 0.03), higher INR (OR 5.67, CI 1.27–25.34, p = 0.02), longer duration of operation (OR 1.03, CI 1.00–1.06, p = 0.04) and tracheotomy during extracorporeal membrane oxygenation (ECMO) support (OR 6.26, CI 1.21–32.44, p = 0.03). STB represents a safe surgical procedure, also suitable for patients with an increased risk profile. Careful evaluation of individual risk factors should be favored to reduce procedure related complications.