title: Prospective observational study of postoperative complications after percutaneous dilatational or surgical tracheostomy in critically ill patients.
abstract: OBJECTIVE
  To assess and describe postoperative complications of single dilator percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) in a large series of critically ill patients.
  
  
  METHODS
  A prospective observational study was conducted in 1163 critically ill patients in a university affiliated tertiary referral hospital between 2002 and 2007. PDT was the procedure of choice for all critically ill patients requiring tracheostomy except for those with an anatomic abnormality or refractory coagulopathy, who underwent ST. Demographic and postoperative complication data were collected in a web-based database.
  
  
  RESULTS
  913 patients (79%) underwent PDT at the bedside in the ICU, and 250 (21%) underwent ST in the operating theatre. The tracheostomy tube was larger, and the duration of tracheostomy cannulation was shorter after PDT than after ST. The postoperative complication rate for PDT was 9.6% compared with 19.6% for ST (P<0.001). Tracheal tube obstruction and displacement were significantly less frequent after PDT (obstruction 1.0% for PDT v 3.6% for ST, P = 0.007; displacement, 1.3% for PDT v 4.8% for ST, P = 0.002).
  
  
  CONCLUSIONS
  In a large heterogeneous group of critically ill patients, single dilator PDT was safe and had few postoperative complications. Although ST was used in higher-risk patients, those who underwent PDT were more likely to receive a larger-sized tracheostomy tube; they were also less likely to experience obstruction or displacement of the postoperative tracheostomy tube. These differences are probably related to a combination of patient selection, smaller, shorter tracheostomy tubes, and larger tissue incision size with ST.
authors.affiliation: Intensive Care Department, Alfred Hospital, Melbourne, VIC. J.Barbetti@alfred.org.au
authors.forename: Julie K
authors.initials: JK
authors.lastname: Barbetti
authors.forename: Alistair D
authors.initials: AD
authors.lastname: Nichol
authors.forename: Kim R
authors.initials: KR
authors.lastname: Choate
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bailey
authors.forename: Geraldine A
authors.initials: GA
authors.lastname: Lee
authors.forename: D James
authors.initials: DJ
authors.lastname: Cooper
mesh_terms: D003422:Critical Care; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014139:Tracheostomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D014739:Victoria / Q000453:epidemiology