Trauma ICU patients requiring tracheostomy: a single-centre experience

Abstract

Background: The tracheostomy is a commonly performed procedure in the context of trauma care. There is paucity of data on factors affecting outcomes after a tracheostomy. This study aims to determine complication and mortality rates of tracheostomies in trauma patients and to determine the association of these outcomes with level of surgeon, urgency of procedure and surgical approach utilised.

Methods: This was a retrospective audit at a single academic hospital. All patients who had tracheostomies performed by trauma unit staff within the unit between 1 June 2016 and 31 May 2023 were included. Clinical variables and outcomes were evaluated.

Results: A total of 247 patients were enrolled in the study. The overall complication rate was 4.86%. There was no significant difference in complication rates when comparing level of surgeon (p < 0.999), urgency of procedure (p = 0.469) or surgical approach (p = 0.444). Thirty-day all-cause mortality rate was 21.05%. There was no significant difference in mortality rates among the different levels of surgeons (p = 0.678) or surgical approach (p = 0.553). Mortality rates were significantly higher (p = 0.022) in elective tracheostomies than emergency tracheostomies.

Conclusion: The use of different surgical approaches did not affect complication or mortality rates of tracheostomies performed. Elective procedures had a higher mortality rate than emergency procedures which suggests urgency alone may not be a risk factor and that burden of injury may need to be considered. Seniority of surgeon did not affect complication or mortality rates. This supports that structured training with adequate supervision allows junior doctors to safely perform such procedures.