TEN-YEAR REVIEW OF TRACHEOSTOMY TECHNIQUES AND RELATED COMPLICATIONS

Objectives: Tracheostomy is a frequently performed procedure that allows for definite airway access. Indications for this procedure revolves around protection of a patient’s airway. In current medical practice, two techniques are used to obtain a tracheal airway, open and percutaneous dilatational tracheostomy. Moreover, there are specific variations in skin and tracheal access techniques. Following tracheostomy, complications associated with the procedure have been well documented in the literature. Tracheostomy can lead to intra-operative and early and late post-operative complications. In this vein, it becomes crucial to examine tracheostomy-related complications in patients and determine if tracheostomy techniques are associated with specific complications. To the best of the authors’ knowledge, the literature still lacks a robust study in this area in a rural setting.

Methods: This is a descriptive retrospective review of adult patients admitted to a rural hospital system between June 2009 and June 2019. Patients who underwent tracheostomy were identified using ICD9 and ICD10 codes. Data were obtained from the institutional trauma registry and electronic medical records.

Results: A total of 1,582 patients were included in the study with a complication rate of 34.3%. Patients on an average had 1.37±0.65 complications ranging from 1 to 4. Open tracheostomy was the most common technique used (93.6%) and majority of them were planned (94.9%). A little more than half of the patients had horizontal incision (55.2%) with a tube location between 2 rings (69.2%). Tube size of 8 Shiley (76.4%) and securing technique with sutures (44.4%) was mostly used in this patient population. Regarding tracheotomy technique, transverse technique was performed in more than one-third of the patients (38.4%).
Additional analyses were conducted to determine association between operative techniques and tracheostomy-related complications. Results showed that overall complications were not significantly associated with tracheostomy technique, tracheotomy technique, securing technique and tube location. However, the rate of complications significantly varied by tube size (p=0.021). The highest complication rate was reported in the 6 Shiley long category (50.0%) followed by 7 Shiley long (46.2%), 6 Shiley (39.6%), 8 Shiely long (37.3%), 8 Shiley (32.7%), 7 Shiley (25.0%) and others (56.8%).

Conclusion: Tracheostomy technique was not associated with complications. Patients experienced comparable complication rates with open and percutaneous techniques. Proceduralist experience and preference, therefore, should continue to determine the best approach and technique for each patient. However, post-tracheostomy complication rate was associated with tube size, and this finding perhaps will guide clinicians with tube size selection.