title: Impact of neck length on the safety of percutaneous and surgical tracheotomy: a prospective, randomized study.
abstract: OBJECTIVE
  To investigate a correlation between neck length and the incidence of complications after both percutaneous and surgical tracheotomy (ST) and to compare the relative safety of the two procedures at our institution.
  
  
  METHODS
  Prospective, randomized study of patients undergoing tracheotomy at a tertiary care center.
  
  
  METHODS
  Forty-three patients evaluated for tracheotomy at our institution between the years 2003 and 2004 were enrolled in the study and were randomly assigned to receive either an ST or a percutaneous dilatational tracheotomy (PDT). All patients underwent standardized measurement of the cricosternal distance (CSD) in the neutral and extended positions before the procedure. Demographic and procedural variables were recorded, and the occurrence of postoperative complications was followed for 1 week.
  
  
  RESULTS
  PDT was performed in 29 patients and ST in 14 patients. The mean CSD of 2.7 cm increased to 3.7 cm after extension with a shoulder roll. PDT required less time (mean 8 vs. 23 minutes) and resulted in less blood loss compared with ST. A trend toward a higher incidence of complications with PDT (40%) compared with ST (7%) and in the first half of our series (learning curve) was noted. This, however, did not reach statistical significance. There was no correlation between the incidence of complications and neck length as determined by the CSD in either group of patients.
  
  
  CONCLUSIONS
  We failed to demonstrate a correlation between CSD and tracheotomy related complications. Patients with short necks may be at no higher risk during either a PDT or ST. Experience, awareness of complications, and a dedicated team approach are necessary for the safe performance of PDT.
authors.affiliation: Departments of Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Abtin
authors.initials: A
authors.lastname: Tabaee
authors.forename: Elvin
authors.initials: E
authors.lastname: Geng
authors.forename: Jerry
authors.initials: J
authors.lastname: Lin
authors.forename: Stylianos
authors.initials: S
authors.lastname: Kakoullis
authors.forename: Brian
authors.initials: B
authors.lastname: McDonald
authors.forename: Hector
authors.initials: H
authors.lastname: Rodriguez
authors.forename: David
authors.initials: D
authors.lastname: Chong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004106:Dilatation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology*; D011183:Postoperative Complications; D011446:Prospective Studies; D012449:Safety; D014140:Tracheotomy / Q000379:methods* / Q000592:standards