Tracheostomy is associated with several complications, with rates quoted as high as 8-45%, including: bleeding; displacement; obstruction; surgical emphysema; pneumothorax; fistulae and failure to decannulate. There are now many studies that confirm the increased length of stay and complications of patients with these temporary tracheostomies. This is a retrospective study from a single centre in Germany of 150 patients with head and neck cancer that were treated between March 2017 and August 2018. All patients had a resection, single or bilateral neck dissection and free flap reconstruction. They also include patients with osteoradionecrosis with microvascular reconstruction (26 patients i.e. 17.3%). Male to female ratio was 1.8:1 and the median age was 63.8. The commonest free flap used was the radial forearm. Post-surgery, all patients spent the first night sedated and a further 10.8% stayed another night. Eighteen patients required ITU admission for pneumonia, delirium, pulmonary embolism, sepsis and cardiac failure. The length of stay varied between five and 66 days with a median stay of 18.11 days. Most patients were decannulated successfully within a range of two to 56 days; the longest was a patient with pneumonia and respiratory failure. In seven cases the cannula had to be reintroduced due to infection/pneumonia. Length of hospital stay ranged from eight to 72 with a mean of 19.83; as expected, patients that had a complication of the tracheostomy stayed longest. Their complication rate is stated as 30%; the commonest one was pneumonia. Risk factors for this were age, pre-existing COPD, alcohol abuse, ASA-3, and length of cannulation of tracheostomy. Unfortunately, in spite of the risks, a temporary tracheostomy is still the safest surgical airway following major ablative head and neck and reconstructive surgery.
Risks of tracheostomy in head and neck cancer
Reviewed by Sunil Kumar Bhatia
Temporary tracheotomy in microvascular reconstruction in maxillofacial surgery: Benefit or threat?
