Impact of neck length on the safety of percutaneous and surgical tracheotomy: a prospective, randomized study.
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.
Tabaee
Abtin
A
Departments of Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Geng
Elvin
E
Lin
Jerry
J
Kakoullis
Stylianos
S
McDonald
Brian
B
Rodriguez
Hector
H
Chong
David
D
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