Comparison of criteria for elective tracheostomy in head and neck cancer surgery

Abstract

Objectives: Elective tracheostomy before resection of a malignancy in head and neck region assures unobstructed ventilation during postoperative period but is associated with an increased risk of complications. We aimed to evaluate retrospectively, how application of elective tracheostomy scales would influence frequency of tracheostomy in comparison with preoperative clinical judgement. Methods: In 205 patients operated from 2013 till 2017 resection of a malignancy involved suprahyoid or pharyngeal muscles, neck dissection and flap reconstruction. Elective tracheostomy decision was made on clinical basis. Score for each patient in 3 published scales has been calculated. Results: In the study group 76 patients had an elective tracheostomy at the outset of a resection procedure. Among 129 patients without elective tracheostomy 9 had a tracheostomy in postoperative period. Indications for elective tracheostomy were calculated for scale I, II and III. Only in 120 patients the decision to perform elective tracheostomy or not would be identical in each scale. Conclusion: Our results suggest that decisions to perform an elective tracheostomy based on the 3 scales has low specificity. The factors used in the published scales should be evaluated in a prospective multicenter study.