title: Retrospective study of tracheostomy indications and perioperative complications on oral and maxillofacial surgery service.
abstract: OBJECTIVE
  Tracheostomy is an extremely common procedure performed by a variety of surgical specialties. The purpose of the present study was to review the intraoperative and perioperative management and complications, present our surgical technique, and discuss the role of our service in providing this care within a large community hospital setting.
  
  
  METHODS
  The 112 patients in our retrospective study were divided into 3 subsets: those referred by medical specialties, tumor/reconstructive surgery patients, and trauma victims. Cases of percutaneous dilational and intensive care unit bedside tracheostomy were excluded. Intraoperative and immediately postoperative complications were included. Bleeding complications were defined as those necessitating a return to the operating room. The patients were followed up for a 24-hour period postoperatively.
  
  
  RESULTS
  The medical referral, tumor/reconstructive, and trauma patients made up 55%, 29%, and 16% of the included patients, respectively. The overall complication rate was 2.7%.
  
  
  CONCLUSIONS
  Conventional open tracheostomy in an operating room is associated with a low complication rate. The low incidence of perioperative bleeding can be attributed to the use of electrocautery in the division of the thyroid isthmus. This service provided an exceedingly safe and efficient surgical treatment by focusing on precise surgical protocols in an operating room setting. Intense coordination of consultation response, operating room scheduling, and communication with other services involved in these patients' care is critical to develop and maintain the privilege to provide this treatment. Our report can be used to educate the medical community regarding the role of an oral and maxillofacial surgery service in providing tracheostomy.
authors.affiliation: Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. ahaspel@valleyhealthlink.com
authors.forename: Alan C
authors.initials: AC
authors.lastname: Haspel
authors.forename: Vincent F
authors.initials: VF
authors.lastname: Coviello
authors.forename: Mark
authors.initials: M
authors.lastname: Stevens
mesh_terms: D016063:Blood Loss, Surgical; D006259:Craniocerebral Trauma / Q000601:surgery; D003796:Dental Service, Hospital; D004564:Electrocoagulation; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery; D006764:Hospitals, Community; D006801:Humans; D007431:Intraoperative Complications; D009873:Operating Rooms; D011030:Pneumothorax / Q000209:etiology; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000209:etiology; D019651:Plastic Surgery Procedures; D012017:Referral and Consultation; D012131:Respiratory Insufficiency / Q000601:surgery; D012189:Retrospective Studies; D012449:Safety; D013352:Subcutaneous Emphysema / Q000209:etiology; D013515:Surgery, Oral; D013997:Time Factors; D014139:Tracheostomy / Q000295:instrumentation / Q000379:methods