An assessment of early tracheostomy after anterior cervical stabilization in patients with acute cervical spine trauma.
BACKGROUND
The optimal timing of tracheostomy after anterior cervical spine surgery remains controversial because of the potential for deep infection. The aims of this study were to compare the infection rates in patients requiring tracheostomy who underwent anterior versus posterior cervical spine surgery, and to report the timing of tracheostomy tube placement in such patients.


METHODS
All patients admitted to a referral Intensive Care Unit for spinal trauma from January 1998 until May 2005, who underwent surgical stabilization with instrumentation and also received a tracheostomy, were retrospectively evaluated for demographic data, severity of neurologic injury, and complications including infection to a surgical site and timing and type of tracheostomy procedure.


RESULTS
We identified 71 patients, all who had a diagnosis of acute cervical spine injury. Thirty-two (45%) underwent anterior stabilization, 15 (21%) had posterior stabilizations, and 24 (34%) required both anterior and posterior approaches. The mean time from stabilization to tracheostomy for an anterior approach was 3.8 +/- 2.6 days. There was no significant difference in the timing of tracheostomy for different surgical approaches. Seventeen patients (25%) had a positive culture of their cervical and or tracheostomy incision site. Only one patient, however, had infection with the same organism at both the tracheostomy site and the anterior stabilization site. Suspected infection was managed with antibiotics and no further surgical intervention was required.


CONCLUSIONS
Early tracheostomy after spinal stabilization is associated with a low risk of infection even after the anterior approach.
Berney
Susan
S
Departments of Physiotherapy, Austin Hospital, Melbourne, Australia. sue.berney@austin.org.au
Opdam
Helen
H
Bellomo
Rinaldo
R
Liew
Susan
S
Skinner
Elizabeth
E
Egi
Moritoki
M
Denehy
Linda
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000628:therapy*; D013997:Time Factors; D014139:Tracheostomy