Tracheostomy experience in Al Noor Specialist Hospital retrospective 8 years experience from Feb. 1994 to Feb. 2002 [1414H to 1422H]

ABSTRACT

To review our Tracheostomy experience regarding indications, age and sex incidences, discuss complication rate and comparing it with international and national similar studies. ENT, ICU, ER, MICU [Minimal Intensive Care Unit] Neurosurgical and pediatric departments in Al-Noor Specialist [Tertiary teaching center], state of Makkah, Saudi Arabia. Out of 435 tracheotomies patients 380 [87.4%] operations done as elective procedure, 55 patients [12.6%] Emergency tracheostomies.122 patients [28.0%] were female and 313 [72.0%]were male patients, with 2.6lmale to female ratio. Paediatric patients were 55 patients [12.6%]; adults were 380 patients [87.4%]. Saudi patients were 178 [41%] and Non-Saudi patients 256 [59%] out of these Resident patients were l40 [32%] and Non-Residents [pilgrim] patients were 117 [27%]. Overall complication rate is 27.6%[120 patients], of these 3 patients [0.7%] pneumothrox, 15 patients [4.3%] had hemorrhage out of these 4 patients [0.9%] had massive hemorrhage, 25 patients[5.7%] suffered from apnea, 3 patients [0.7%] developed cardiac arrest, 8 patients [1.8%] with cricoids cartilage damage, 20 patients [4.8%] had T. tube dislodgment, 10 patients [2.3%] developed surgical emphysema, 15 patients [3.4%] had peristomal infection, 1 patient [0.2%] had tracheal necrosis, 4 patients [0.9%] developed tracheo-esophegeal fistula, 10 patients [2.3%] developed subglottic stenosis, 5 patients [1.1%] had difficult decannulation, 2 patients [0.5%]developed tracheo-cutaneous fistula 51%of tracheostomies were due to surgical reason, 165 patients [38%] had neurosurgical indications out of these 142 patients [86%] head injuries.33 patients [7.6%] had ENT indications,9 patients [2%] Maxillofacial indications, 15 patients [3.4%]general surgery indications, 2 patients [0.5%] vascular surgery indications. Non surgical [medical] indications represented 49% [213 cases] commonest indication was respiratory diorders22.5% [98 cases], followed by neurological disorders 12% [53 cases], cardiac disorders 11 .5%[50 cases], general medical disorders 1.4% [6 cases] and nephrology disorders 1 .4%[6 cases]. Although our tracheostomy experience is comparable to the similar national and international studies with lower complication rate specially certain complications, still tracheostomy carries significant morbidity specially in makkah during Hajj season where more than 2 million pilgrims from outside Saudi Arabia gathers in Makka with different diseases back grounds it can be minimized by improving the health service, education, surgical skills, preoperative and postoperative care