Airway-Associated Complications With and Without Primary Tracheotomy in Oral Squamous Cell Carcinoma Surgery.
J Craniofac Surg
; 34(1): 279-283, 2023.
Article
in En
| MEDLINE
| ID: mdl-35949029
ABSTRACT
PURPOSE:
This study analyzes postoperative airway management, tracheotomy strategies, and airway-associated complications in patients with oral squamous cell carcinoma in a tertiary care university hospital setting. MATERIAL ANDMETHODS:
After institutional approval, airway-associated complications, tracheotomy, length of hospital stay (LOHS), and length of intensive care unit stay were retrospectively recorded. Patients were subdivided in primarily tracheotomized and not-primarily tracheotomized. Subgroup analyses dichotomized the not-primarily tracheotomized patients into secondary tracheotomized and never tracheotomized. Associations were calculated using regression analyses. A multivariate regression model was used to determine risk factors for secondary tracheotomy.RESULTS:
A total of 207 patients were included. One hundred fifty-three patients (73.9%) were primarily tracheotomized. Primarily tracheotomized patients showed longer LOHS [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.07, P =0.008] but decreased need for reventilation within the intensive care unit stay (OR 0.39, 95% CI 0.15-0.99, P =0.05) compared with not-primarily tracheotomized patients. Within the not-primarily tracheotomized patients, secondary tracheotomized during the hospital stay was needed in 15 of 54 patients (27.8%). In secondary tracheotomized patients, airway management due to respiratory failure was required in 6/15 (40%) patients resulting in critical airway situations in 3/6 (50%) patients. Multivariate regression model showed secondary tracheotomy-associated with bilateral neck dissection (OR 5.93, 95% CI 1.22-28.95, P =0.03) and pneumonia (OR 16.81, 95% CI 2.31-122.51, P =0.005).CONCLUSION:
Primary tracheotomy was associated with extended LOHS, whereas secondary tracheotomy was associated with increased complications rates resulting in extended length of intensive care unit stay. Especially in not-primarily tracheotomized patients, careful individualized patient evaluation and critical re-evaluation during intensive care unit stay is necessary to avoid critical airway events.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Mouth Neoplasms
/
Carcinoma, Squamous Cell
/
Head and Neck Neoplasms
Type of study:
Prognostic_studies
/
Risk_factors_studies
Limits:
Humans
Language:
En
Journal:
J Craniofac Surg
Journal subject:
ODONTOLOGIA
Year:
2023
Type:
Article
Affiliation country:
Germany