title: Morbidity and mortality associated with tracheotomy procedure in a university medical centre.
abstract: This prospective study assessed the morbidity and mortality associated with 192 consecutive tracheotomies. Complications were assessed including intraoperative and/or postoperative bleeding, infection, tracheoinnominate fistulae, tracheoesophageal fistulae, dislodgement of the tracheotomy tube, pneumothorax, wound infection and obstruction of the airway. 16% of the tracheotomy procedures resulted in complications. 22 tracheotomy procedures (11%) resulted in postoperative bleeding, 6 procedures (3%) had intraoperative bleeding which exceeded an estimated blood loss of 5 cc and 2 procedures (1%) developed a tracheoesophageal fistula. One patient (0.5%) experienced airway distress related to obstruction of the airway proximal to the tracheotomy tube. No patients required a return to the operating room to manage their complication, no patients developed a tracheoinnominate fistula and none of the tracheotomy sites became infected. The post tracheotomy ventilator wean to trach-collar supplemental oxygen protocol was accomplished with a mean of 6 days in 119 patients for whom data was available. Results demonstrate that the open tracheotomy procedure is a safe and frequently life saving manoeuvre in situations with an unsecured airway, and it provides better outcomes in patients requiring long term ventilatory support. Mortality rates are low and its potential morbidity is exceeded by its benefits.
authors.affiliation: Tufts University School of Dental Medicine, Tufts Medical Center, Boston, MA 02111-1513, USA.
authors.forename: D
authors.initials: D
authors.lastname: Oreadi
authors.forename: E R
authors.initials: ER
authors.lastname: Carlson
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology; D016063:Blood Loss, Surgical; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000601:surgery; D018570:Risk Assessment; D012449:Safety; D013997:Time Factors; D014138:Tracheoesophageal Fistula / Q000209:etiology; D014140:Tracheotomy / Q000009:adverse effects* / Q000295:instrumentation; D016896:Treatment Outcome; D015300:Ventilator Weaning; D055815:Young Adult