Anastomotic complications after tracheal resection: prognostic factors and management.
OBJECTIVE
We sought to identify risk factors for anastomotic complications after tracheal resection and to describe the management of these patients.


METHODS
This was a single-institution, retrospective review of 901 patients who underwent tracheal resection.


RESULTS
The indications for tracheal resection were postintubation tracheal stenosis in 589 patients, tumor in 208, idiopathic laryngotracheal stenosis in 83, and tracheoesophageal fistula in 21. Anastomotic complications occurred in 81 patients (9%). Eleven patients (1%) died after operation, 6 of anastomotic complications and 5 of other causes (odds ratio 13.0, P = .0001 for risk of death after anastomotic complication). At the end of treatment, 853 patients (95%) had a good result, whereas 37 patients (4%) had an airway maintained by tracheostomy or T-tube. The treatments of patients with an anastomotic complication were as follows: multiple dilations (n = 2), temporary tracheostomy (n = 7), temporary T-tube (n = 16), permanent tracheostomy (n = 14), permanent T-tube (n = 20), and reoperation (n = 16). Stepwise multivariable analysis revealed the following predictors of anastomotic complications: reoperation (odds ratio 3.03, 95% confidence interval 1.69-5.43, P = .002), diabetes (odds ratio 3.32, 95% confidence interval 1.76-6.26, P = .002), lengthy (> or =4 cm) resections (odds ratio 2.01, 95% confidence interval 1.21-3.35, P = .007), laryngotracheal resection (odds ratio 1.80, 95% confidence interval 1.07-3.01, P = .03), age 17 years or younger (odds ratio 2.26, 95% confidence interval 1.09-4.68, P = .03), and need for tracheostomy before operation (odds ratio 1.79, 95% confidence interval 1.03-3.14, P = .04).


CONCLUSIONS
Tracheal resection is usually successful and has a low mortality. Anastomotic complications are uncommon, and important risk factors are reoperation, diabetes, lengthy resections, laryngotracheal resections, young age (pediatric patients), and the need for tracheostomy before operation.
Wright
Cameron D
CD
Division of General Thoracic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA. Wright.Cameron@mgh.harvard.edu
Grillo
Hermes C
HC
Wain
John C
JC
Wong
Daniel R
DR
Donahue
Dean M
DM
Gaissert
Henning A
HA
Mathisen
Douglas J
DJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006097:Granulation Tissue; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000628:therapy*; D014132:Trachea / Q000601:surgery*; D014133:Tracheal Diseases / Q000601:surgery*; D014135:Tracheal Stenosis / Q000209:etiology / Q000628:therapy; D014140:Tracheotomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing