Retrospective Review of Acute Post-Tracheostomy Complications in
Patients with Obstructive Pulmonary Diseases
Abstract
Objective Tracheostomy is performed for various indications ranging from
prolonged ventilation to airway obstruction. Many factors may play a
role in the incidence of complications in the immediate post-operative
period including patient-related factors. The relationship between
obstructive pulmonary diseases and acute post-tracheostomy complications
has been incompletely studied. Chronic obstructive pulmonary disease
(COPD), obstructive sleep apnea (OSA), and asthma are some of the most
common pulmonary pathologies in the United States and given the clinical
utility of tracheostomies among these patients, it is important to
characterize the risk of acute post-operative complications. Design A
retrospective chart review identified tracheostomy patients from January
2017 through December 2018 at an academic cancer center. Medical records
were reviewed for the technique used, complications, and contributing
patient factors. Post-operative complications were defined as any
tracheostomy-related adverse event occurring within 14 days. Patient
factors examined included demographics, comorbidities, and body mass
index (BMI). Results The most common indication for tracheostomy among
the 321 patients that met inclusion criteria was airway obstruction or a
head and neck cancer surgical procedure. Obstructive pulmonary pathology
(COPD, OSA, asthma) was moderately associated with acute complications
in bivariate analysis (13.4% complications, p = 0.039). Among the
secondary outcomes measured, radiation was associated with early
complications occurring in post-operative days 0-6 (1.1%, p = 0.029).
Conclusion Obstructive pulmonary patients may have a higher risk of
acute post-tracheostomy complications which is clinically significant
when considering the utility of ventilation and tracheostomy in the
management of acute respiratory failure secondary to these conditions.