Open-Tracheostomy: Audit at King George Medical University, India

Abstract

Objective: Audit of open tracheostomies in terms of their indications and outcomes.

Methodology: 500 open tracheostomies were studied for indications of tracheostomy, patient’s age, gender, diagnosis, referring facility and complications as mentioned in the archival register along with reasons for deferral of the procedure.

Results: A predominance of males and elective tracheostomy was seen. The most common indication for emergency tracheostomy in adults was laryngeal malignancy, followed trauma while in paediatric population, the various infectious conditions. Cerebrovascular cases were the most common ones referred from medicine ward/ ICU for elective tracheostomy. The short-term complications were haemorrhage, subcutaneous emphysema and difficult insertion/ false placement, while reasons for deferral were deranged coagulation profile, negative patient-consent and low platelet count.

Discussion: The acute complications were comparatively much less than reported in the literature. Even in the absence of data on long-term mortality we certainly anticipate a much lesser mortality. The hemorrhage in this series was possibly due to a restless patient under local anaesthesia often laid on an unstable platform (ward bed) and without diathermy. In addition, injury to thyroid isthmus with thyroid hook can cause abrasion and open tracheostomy is better to access the ‘injured’ tissue. Insufficient intraoperative haemostasis is likely to result in significant postoperative bleeding. Intraoperative mortality related to tracheostomy remains low (0.4%) possibly related to cardiopulmonary arrest.

Conclusion: Open mid tracheostomy under local anaesthesia conducted primarily by residents gives comparable results and should be adapted in a low-resource centre with a huge patient load.