ABSTRACT
Enhanced experience in performing percutaneous tracheostomies during the COVID-19 pandemic resulted in changes to airway management protocol for patients undergoing major head and neck reconstructive surgery within our department. Most patients now receive a percutaneous tracheostomy over the previously favoured surgical tracheostomy. The aim of this study was to review our experience in performing percutaneous tracheostomies, whilst comparing complication rates with surgical tracheostomies performed in similar settings. All consecutive patients undergoing free flap reconstructive surgery for head and neck cancer between June 2020 and November 2021 were included, with 56 patients receiving a percutaneous tracheostomy. Data across a range of variables including age, BMI, comorbidities and complications was compared with 56 surgical tracheostomies performed for the same group of patients before the COVID-19 pandemic and resultant protocol changes. In the percutaneous group, a marginally lower complication rate was observed over the surgical tracheostomy group;28.57% and 30.35% respectively. Analysis of the 16 patients who experienced complications in the percutaneous group led to development of selection criteria to identify appropriate patients to receive a percutaneous tracheostomy in future, based on factors such as BMI, bleeding risk and positioning deformities. The COVID-19 pandemic has offered a multitude of learning experiences for healthcare professionals to change our practice. In our unit, this has involved modifying the routine tracheostomy procedure used for airway management intra- and post-operatively in major head and neck reconstruction surgery.Copyright © 2023 The Authors
ABSTRACT
Introduction/Aims: Enhanced experience in performing percutaneous dilatational tracheostomies (PDT) during the COVID-19 pandemic resulted in changes to airway management for patients undergoing head and neck reconstructive surgery at Queen Elizabeth Hospital Birmingham. All patients now receive a percutaneous tracheostomy over the previously favoured surgical tracheostomy (ST), unless contraindicated. This ambispective case series aimed to review experiences in performing percutaneous tracheostomies, whilst comparing complication rates with surgical tracheostomies performed in similar settings. In addition, we propose a selection criteria for identifying patients suitable for PDT. Material(s) and Method(s): All patients undergoing free flap reconstruction for head and neck cancer treatment between June 2020-November 2021 were included, with 56 patients receiving PDT. This was compared with data of 56 ST performed before the COVID-19 pandemic. Results/Statistics: In the percutaneous group, a marginally lower complication rate was observed over the surgical tracheostomy group;28.57% and 30.35% respectively. Although not statistically significant, time to decannulation was slightly lower in PDT group (5.8 days) compared to ST group (7.3 days). An additional observed advantage included quicker tracheostomy wound healing with PDT. Analysis of the 16 patients who experienced complications with PDT aided development of the selection criteria for identifying patients for percutaneous tracheostomy. This selection criteria considers BMI, ASA, bleeding risk and positioning deformities. Conclusions/Clinical Relevance: This study has demonstrated PDT to be an equally safe and successful technique with a similar complication rate to ST in head and neck cancer reconstruction surgery. Moving forward, further studies with larger sample sizes would be recommended to draw conclusions. Copyright © 2022