Retrospective analysis of open bedside tracheotomies in a German tertiary care university hospital.

Riekert, Maximilian; Kreppel, Matthias; Schminke, Philipp; Weckx, Annelies; Zöller, Joachim E; Schick, Volker C

OBJECTIVE Open surgical tracheotomy performed beside (STB) is a standardized procedure in critical ill patients. The aim of the study was to evaluate perioperative complications and the safety of STB in a tertiary care university hospital setting. MATERIALS AND METHODS Intra- and postoperative complications were retrospectively recorded and associations based on the evaluation of clinical and laboratory parameters were studied using regression analyses. RESULTS A total of 562 patients were included. Early tracheotomy shortened ventilation time after tracheotomy (ventilation before STB ≤ 5 days: mean 9.2 ± 9.1 days; ventilation before STB ≥ 6 days: mean 11.5 ± 10.5 days, p = 0.0001). Overall complications were found in 30/562 cases (5.3%), major complications in 12/562 cases (2.1%). Significant risk factors for overall tracheotomy related complications were higher body mass index (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.01-1.07, p = 0.02), lower CRP (OR 0.99, CI 0.99-1.00, p = 0.03), higher INR (OR 5.67, CI 1.27-25.34, p = 0.02), longer duration of operation (OR 1.03, CI 1.00-1.06, p = 0.04) and tracheotomy during extracorporeal membrane oxygenation (ECMO) support (OR 6.26, CI 1.21-32.44, p = 0.03). CONCLUSION STB represents a safe surgical procedure, also suitable for patients with an increased risk profile. Careful evaluation of individual risk factors should be favored to reduce procedure related complications.