Predictors of Complications Occurrence Associated With Emergency Surgical Tracheotomy

• Published in: Otolaryngology-head and neck surgery Vol. 164; no. 2; pp. 346 - 352
• Main Authors: Jotic, Ana D., Milovanovic, Jovica P., Trivic, Aleksandar S., Folic, Miljan M., Krejovic-Trivic, Sanja B., Radin, Zorana Z., Buta, Marko N., Milicic, Biljana R.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-02-2021
• Subjects: Airway Obstruction - surgery; Emergencies; emergency surgical tracheotomy; Global Health; Humans; Incidence; Postoperative Complications - epidemiology; predictors; Retrospective Studies; tracheostomy complication; tracheostomy‐related mortality; Tracheotomy - adverse effects; predictors; tracheostomy complication; emergency surgical tracheotomy; tracheostomy-related mortality
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599820947001

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.