Abstract
Objective : Although various guidelines have been established
for the management of antithrombotic therapy during surgical treatments,
surgical tracheostomy (ST) under
continued antithrombotic therapy (CAT) remains a challenge. We
investigated the risk factors for complications after ST by focusing on
CAT use during ST.
Method : Patients’ medical records from 2009 to 2020 were
reviewed in this retrospective study. We selected patients who underwent
ST at the Department of Otolaryngology of our hospital. Patient
demographics, complications, and blood test values were recorded and
statistically analyzed to identify the risk factors for postoperative
complications.
Results : We identified 288 patients (median age: 64 years; 184
men [64%]), among whom 40 (median age: 67 years; 29 men [73%])
underwent CAT. Although the patients undergoing CAT had significantly
higher values of activated partial thromboplastin time (p = 0.002) and
prothrombin time-international normalized ratio (p = 0.006) than those
of antithrombotic naïve patients, no statistically significant
intergroup differences were observed in the risks of bleeding,
infection, or subcutaneous emphysema. Instead, ST under local anesthesia
(p = 0.01) and ST for airway emergency (p = 0.02) significantly
increased the risk of early postoperative complications.
Conclusion : The results of the present study suggest that
ST under CAT can be safely
performed without any increased risk of postoperative complications.
Nevertheless, surgeons should be extra cautious about early
complications after ST under local anesthesia without intubation or ST
for airway emergency.
Key points :
1. We aimed to investigate the risk factors for complications after ST
by focusing on CAT use during ST.
2. Patients undergoing CAT had significantly higher values of APTT and
PT-INR than those of antithrombotic naïve patients.
3. ST under CAT can be safely performed without any increased risk of
postoperative complications.
4. ST under local anesthesia and airway emergency was a risk factor for
complications after ST.
5. Among the complications, subcutaneous emphysema was significantly
more frequent in ST under local anesthesia and under airway emergency.