Tracheostomy Avoidance in Flap Reconstruction of the Upper Aerodigestive Tract is Safe in Selected Patients.
airway management
free flap
reconstruction
regional flap
tracheostomy
Journal
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
ISSN: 1097-6817
Titre abrégé: Otolaryngol Head Neck Surg
Pays: England
ID NLM: 8508176
Informations de publication
Date de publication:
30 Aug 2024
30 Aug 2024
Historique:
revised:
06
08
2024
received:
31
01
2024
accepted:
18
08
2024
medline:
31
8
2024
pubmed:
31
8
2024
entrez:
30
8
2024
Statut:
aheadofprint
Résumé
Assess the impact of tracheostomy on postoperative morbidity and mortality and examine factors that predicted tracheostomy in head and neck flap patients. Retrospective cohort January 2017 to December 2021. Single tertiary center. Adult patients undergoing head and neck flap reconstruction were included, excluding cutaneous reconstruction, laryngectomy, or with tracheostomy present at surgery. Patients were routinely extubated immediately following surgery. Univariate and multivariable analyses examined associations between tracheostomy and postoperative outcomes and identified predictors of tracheostomy. We included 193 patients, 69 (35.8%) with tracheostomy and 124 (64.2%) without. Tracheostomy avoidance was associated with no difference in 30-day mortality (P = .531) and with decreased likelihood of 30-day complications (0.019), unplanned return to the operating room (0.021), and discharge to a facility (<0.001) and with 2.2 decrease in length of stay on multivariable analysis (confidence interval [CI]: 0.62-3.82, P = .007). Four patients (2.1%) required reactive tracheostomy with no resulting mortalities. Significant associations with tracheostomy on multivariable analysis included bilateral neck dissections (odds ratio [OR]: 3.13, CI 1.12-9.06, P = .030), number of resected mandibular subsites (OR: 2.65, CI: 1.50-5.67, P = .0023), specimen volume (OR: 1.87, CI: 1.29-2.71, P = .001), body mass index < 20 (OR: 3.80, CI: 1.24-11.64, P = .019), mandibulectomy (OR: 0.04, CI: 0.01-0.22, P < .001), forearm flap (OR: 0.15, CI: 0.05-0.41, P < .001), oral cavity site (OR: 0.21, CI: 0.06-0.73, P = .014), and age > 70 (OR: 0.33, CI: 0.14-0.81, P = .016). Tracheostomy avoidance is safe in properly selected patients undergoing head and neck flap reconstruction. Multiple factors predicted tracheostomy, which may guide patient selection at other centers.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.
Références
Madgar O, Livneh N, Dobriyan A, Dagan E, Alon EE. Airway management following head and neck microvascular reconstruction: is tracheostomy mandatory? Braz J Otorhinolaryngol. 2022;88:S44‐S49. doi:10.1016/j.bjorl.2021.07.007
Castling B, Telfer M, Avery BS. Complications of tracheostomy in major head and neck cancer surgery; a retrospective study of 60 consecutive cases. Br J Oral Maxillofac Surg. 1994;32(1):3‐5. doi:10.1016/0266-4356(94)90162-7
Marsh M, Elliott S, Anand R, Brennan PA. Early postoperative care for free flap head & neck reconstructive surgery—a national survey of practice. Br J Oral Maxillofac Surg. 2009;47(3):182‐185.
Panayi AC, Haug V, Kauke‐Navarro M, Foroutanjazi S, Diehm YF, Pomahac B. The modified 5‐item frailty index is a predictor of perioperative risk in head and neck microvascular reconstruction: an analysis of 3795 cases. Am J Otolaryngol. 2021;42(6):103121.
Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3(1):17.
Heinze G, Wallisch C, Dunkler D. Variable selection—a review and recommendations for the practicing statistician. Biometrical J. 2018;60(3):431‐449.
Cramer JD, Samant S, Greenbaum E, Patel UA. Association of airway complications with free tissue transfer to the upper aerodigestive tract with or without tracheotomy. JAMA Otolaryngol Head Neck Surg. 2016;142(12):1177‐1183.
Moubayed SP, Barker DA, Razfar A, Nabili V, Blackwell KE. Microvascular reconstruction of segmental mandibular defects without tracheostomy. Otolaryngol Head Neck Surg. 2015;152(2):250‐254.
Lapis PN, DeLacure MD, Givi B. Factors in successful elimination of elective tracheotomy in mandibular reconstruction with microvascular tissue. JAMA Otolaryngol Head Neck Surg. 2016;142(1):46‐51.
Brickman DS, Reh DD, Schneider DS, Bush B, Rosenthal EL, Wax MK. Airway management after maxillectomy with free flap reconstruction. Head Neck. 2013;35(8):1061‐1065.
Wu TJ, Saggi S, Badran KW, Han AY, Sand JP, Blackwell KE. Radial forearm free flap reconstruction of glossectomy defects without tracheostomy. Ann Otol Rhinol Laryngol. 2022;131(6):655‐661.
Moore MG, Bhrany AD, Francis DO, Yueh B, Futran ND. Use of nasotracheal intubation in patients receiving oral cavity free flap reconstruction. Head Neck. 2010;32(8):1056‐1061.
Gigliotti J, Cheung G, Suhaym O, Agnihotram RV, El‐Hakim M, Makhoul N. Nasotracheal intubation: the preferred airway in oral cavity microvascular reconstructive surgery? J Oral Maxillofac Surg. 2018;76(10):2231‐2240.
Dawson R, Phung D, Every J, et al. Tracheostomy in free‐flap reconstruction of the oral cavity: can it be avoided? A cohort study of 187 patients. ANZ J Surg. 2021;91(6):1246‐1250.
Coyle MJ, Tyrrell R, Godden A, et al. Replacing tracheostomy with overnight intubation to manage the airway in head and neck oncology patients: towards an improved recovery. Br J Oral Maxillofac Surg. 2013;51(6):493‐496.
Cameron M, Corner A, Diba A, Hankins M. Development of a tracheostomy scoring system to guide airway management after major head and neck surgery. Int J Oral Maxillofac Surg. 2009;38(8):846‐849. doi:10.1016/j.ijom.2009.03.713
Mohamedbhai H, Ali S, Dimasi I, Kalavrezos N. TRACHY score: a simple and effective guide to management of the airway in head and neck cancer. Br J Oral Maxillofac Surg. 2018;56(8):709‐714.
Kircheva DY, Husain AN, Watson S, Kindler HL, Durkin A, Vigneswaran WT. Specimen weight and volume: important predictors of survival in malignant pleural mesothelioma. Eur J Cardiothorac Surg. 2016;49(6):1642‐1647.
Shah RK, Lander L, Berry JG, Nussenbaum B, Merati A, Roberson DW. Tracheotomy outcomes and complications: a national perspective. Laryngoscope. 2012;122(1):25‐29.
Patel RS, McCluskey SA, Goldstein DP, et al. Clinicopathologic and therapeutic risk factors for perioperative complications and prolonged hospital stay in free flap reconstruction of the head and neck. Head Neck. 2010;32(10):1345‐1353.
McVeigh KP, Moore R, James G, Hall T, Barnard N. Advantages of not using the intensive care unit after operations for oropharyngeal cancer: an audit at Worcester Royal Hospital. Br J Oral Maxillofac Surg. 2007;45(8):648‐651. doi:10.1016/j.bjoms.2007.05.003
Das P, Zhu H, Shah RK, Roberson DW, Berry J, Skinner ML. Tracheotomy‐related catastrophic events: results of a national survey. Laryngoscope. 2012;122(1):30‐37. doi:10.1002/lary.22453
Schütz P, Hamed HH. Submental intubation versus tracheostomy in maxillofacial trauma patients. J Oral Maxillofac Surg. 2008;66(7):1404‐1409. doi:10.1016/j.joms.2007.12.027
Ong S‐K, Morton RP, Kolbe J, Whitlock RM, McIvor NP. Pulmonary complications following major head and neck surgery with tracheostomy: a prospective, randomized, controlled trial of prophylactic antibiotics. Arch Otolaryngol Head Neck Surg. 2004;130(9):1084‐1087.
Crosher R, Baldie C, Mitchell R. Selective use of tracheostomy in surgery for head and neck cancer: an audit. Br J Oral Maxillofac Surg. 1997;35(1):43‐45. doi:10.1016/s0266-4356(97)90008-5
Halfpenny W, McGurk M. Analysis of tracheostomy‐associated morbidity after operations for head and neck cancer. Br J Oral Maxillofac Surg. 2000;38(5):509‐512. doi:10.1054/bjom.2000.0310
Rogers SN, Russell L, Lowe D. Patients' experience of temporary tracheostomy after microvascular reconstruction for cancer of the head and neck. Br J Oral Maxillofac Surg. 2017;55(1):10‐16.