title: Pneumothorax after tracheostomy: A prospective study.
abstract: OBJECTIVE
  To determine the incidence of pneumothorax after tracheostomy with a prospective study design.
  
  
  BACKGROUND
  The incidence of post-tracheostomy pneumothorax in literature varies from 0 to 17%. All studies are of retrospective chart review design that can cause the selection bias.
  
  
  METHODS
  Prospective, non-randomized study in a single tertiary hospital in Bangkok, Thailand. A total of 100 patients underwent tracheostomies between October 2012 and September 2013. Chest radiography was performed in each case post-operatively. The main outcome measurements were incidence of pneumothorax and complications. Patients were categorized as emergency surgery and patients with suspicious signs or symptoms after surgery, and were analyzed.
  
  
  RESULTS
  In 100 tracheostomy cases, the overall complication rate was 14%. The most common complication was minor hemorrhage (4%), followed by major hemorrhage (3%). The overall incidence of pneumothorax was 1%. Subgroup analyses revealed a 20-fold higher incidence in emergency cases compared to the overall sample.
  
  
  CONCLUSIONS
  With this prospective design study, we reported a 1% incidence of pneumothorax after tracheostomy. A routine post-operative chest radiograph is unnecessary. Emergency tracheostomy patients with suspicious signs or symptoms are at markedly increased risk and may benefit from a post-operative chest radiograph.
authors.forename: Porawit
authors.initials: P
authors.lastname: Panajaroen
authors.affiliation: Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Napadon
authors.initials: N
authors.lastname: Tangjaturonrasme
mesh_terms: D006801:Humans; D015994:Incidence; D010039:Otorhinolaryngologic Neoplasms / Q000601:surgery*; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011184:Postoperative Period; D011446:Prospective Studies; D013902:Radiography, Thoracic; D013785:Thailand; D014140:Tracheotomy / Q000009:adverse effects*