Affiliation:
1. Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
2. Section Phoniatrics and Pediatric Audiology, Department of Otolaryngology, University Hospital Regensburg, 93053 Regensburg, Germany
Abstract
Elective tracheotomy (ET) secures the airway and prevents adverse airway-related events as unplanned secondary tracheotomy (UT), prolonged ventilation (PPV) or nosocomial infection. The primary objective of this study was to identify factors predisposing for airway complications after reconstructive lower ja surgery. We reviewed records of patients undergoing mandibulectomy and microvascular bone reconstruction (N = 123). Epidemiological factors, modus of tracheotomy regarding ET and UT, postoperative ventilation time and occurrence of hospital-acquired pneumonia HAP were recorded. Predictors for PPV and HAP, ET and UT were identified. A total of 82 (66.7%) patients underwent tracheotomy of which 12 (14.6%) were performed as UT. A total of 52 (42.3%) patients presented PPV, while 19 (15.4%) developed HAP. Increased operation time (OR 1.004, p = 0.005) and a difficult airway (OR 2.869, p = 0.02) were predictors, while ET reduced incidence of PPV (OR 0.054, p = 0.006). A difficult airway (OR 4.711, p = 0.03) and postoperative delirium (OR 6.761, p = 0.01) increased UT performance. HAP increased with anesthesia induction time (OR 1.268, p = 0.001) and length in ICU (OR 1.039, p = 0.009) while decreasing in ET group (HR 0.32, p = 0.02). OR for ET increased with mounting CCI (OR 1.462, p = 0.002) and preoperative radiotherapy (OR 2.8, p = 0.018). ET should be strongly considered in patients with increased CCI, preoperative radiotherapy and prolonged operation time. ET shortened postoperative ventilation time and reduced HAP.
Reference42 articles.
1. Free-Flap Reconstruction of the Tongue;Vincent;Semin. Plast. Surg.,2019
2. Mandibular Reconstruction with Different Techniques;Torroni;J. Craniofac. Surg.,2015
3. Meier, J., Wunschel, M., Angermann, A., Ettl, T., Metterlein, T., Klingelhöffer, C., Reichert, T.E., and Ritzka, M. (2019). Influence of early elective tracheostomy on the incidence of postoperative complications in patients undergoing head and neck surgery. BMC Anesthesiol., 19.
4. Indications for Elective Tracheostomy in Reconstructive Surgery in Patients with Oral Cancer;Leiser;J. Craniofac. Surg.,2017
5. Association of Airway Complications with Free Tissue Transfer to the Upper Aerodigestive Tract with or without Tracheotomy;Cramer;JAMA Otolaryngol. Head Neck Surg.,2016
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