Background: Tracheostomy is a lifesaving procedure used globally. As with other surgeries open, surgical tracheostomies do not go without risks and complications. The aim of this study was to determine the common indications and predictors of early complications among patients undergoing open tracheostomies. Methods: This was a prospective cross sectional study that included 56 patients who underwent open tracheostomy at Bugando Medical Centre from January to July 2019. After tracheostomy, characteristics were determined, and patients were followed up for seven days to determine complications. Univariate logistic analysis followed by multivariate logistic regression analysis was performed to determine predictors of early complications. Results: The age ranged from 14 days – 80 years, and median 40 years. Male were 41 (73.2%) and 15 (26.8%) females. About 31 (55.4%) had elective tracheostomy. The commonest indications were upper airway obstruction 27 (48.2%), prolonged intubation 19 (33.4%), adjunct to major head and neck surgery 7 (12.5%) and airway protection 3 (5.4%). The complications rate was 32% and recorded tracheostomy tube blockage 9 (42.8%), false tracheostomy 3 (14.3%), wound infection 3 (14.3%), surgical emphysema 2 (9.5%), apnea 2 (9.5%), haemorrhage 1 (4.8%) and tube dislodgement 1 (4.8%). Increased age (OR 1.3; 95% CI 1.00 - 1.06; p = 0.048) was the only significant factor. Overall, 3.6% tracheostomy related mortality was recorded. Conclusion: The most common indications are upper airway obstruction followed by prolonged intubation, adjunct to head and neck surgery and lower airway protection. The most common complications were tracheostomy tube blockage, false tracheostomy and wound infections. Increased age was the only significant predictor.
References
[1]
Bradley, P.J. (1997) Management of Obstructed Airway and Tracheostomy. In: Kerr, A.G. and Hibbert, J., Eds., Scott Brown’s Otolaryngology, Butterworth-Heinemann, 1-20.
[2]
Amusa, Y.B., Akinpelu, V.O., Fadiora, S.O., et al. (2004) Tracheostomy in Surgical Practice: Experience in a Nigerian Tertiary Hospital. West African Journal of Medicine, 23, 32-34. https://doi.org/10.4314/wajm.v23i1.28077
[3]
Fang, C.H., Friedman, R., White, P.E., et al. (2015) Emergent Awake Tracheostomy—The Five-Year Experience at an Urban Tertiary Care Center. The Laryngoscope, 125, 2476-2479. https://doi.org/10.1002/lary.25348
[4]
Rajesh, O. and Meher, R. (2005) Historical Review of Tracheostomy. The Internet Journal of Otorhinolaryngology, 4, 1-4.
[5]
Stock, C.R. (1987) What Is Past Is Prologue. A Short History of Tracheostomy. Ear, Nose & Throat Journal, 66, 166-169.
[6]
nil Hamza, A., Khan, Q., Zada, B. and Wahid, F. (2012) An Audit of Tracheostomy at a Tertiary Care Hospital. Otorhinolaryngologic Surgical Procedures, 26, 206-211.
[7]
Kutsukutsa, J., Mashamba-Thompson, T.P. and Saman, Y. (2017) Tracheostomy Decannulation Methods and Procedures in Adults: A Systematic Scoping Review Protocol. Systematic Reviews, 6, Article No. 239. https://doi.org/10.1186/s13643-017-0634-0
[8]
Adetinuola, E.J., Bola, A.Y., Olanrewaju, M.I., et al. (2011) Tracheostomy in SouthWestern Nigeria: Any Change in Pattern? Journal of Medicine and Medical Science, 2, 997-1002.
[9]
Alabi, B.S., Afolabi, O.A., Dunmade, A.D., et al. (2018) Indications and Outcome of Tracheostomy in Ilorin, North Central Nigeria: 10 Years Review. Annals of African Medicine, 17, 1-6. https://doi.org/10.4103/aam.aam_130_16
[10]
Punjabi, S.K. (2015) Complications of Tracheostomy at Tertiary Care Hospital. Pakistan Oral & Dental Journal, 34, 609-612.
[11]
Gilyoma, J.M., Balumuka, D.D. and Chalya, P.L. (2011) Ten-Year Experiences with Tracheostomy at a University Teaching Hospital in Northwestern Tanzania: A Retrospective Review of 214 Cases. World Journal of Emergency Surgery, 6, Article No. 38. http://www.wjes.org/content/6/1/38 https://doi.org/10.1186/1749-7922-6-38
[12]
Russell, C. and Matta, B. (2004) Tracheostomy a Multiprofessional Handbook. Cambridge University Press.
[13]
Krishnan, K., Elliot, S.C. and Mallick, A. (2005) The Current Practice of Tracheostomy in the United Kingdom: A Postal Survey. Anaesthesia, 60, 360-364. https://doi.org/10.1111/j.1365-2044.2004.04106.x
[14]
Shay, S., Shapiro, N.L. and Bhattacharyya, N. (2017) Revisits after Pediatric Tracheotomy: Airway Concerns Result in Returns. International Journal of Pediatric Otorhinolaryngology, 104, 5-9. https://doi.org/10.1016/j.ijporl.2017.10.021
[15]
Muhammad, R., Khan, F., Rehman, F., et al. (2012) Early Complications of Elective and Emergency Tracheostomy. Journal of Ayub Medical College Abbottabad, 24, 44-47.
[16]
Morris, L.L., Whitmer, A. and Mcintosh, E. (2013) Tracheostomy Care and Complications in the Intensive Care Unit. Critical Care Nurse, 33, 18-30. https://doi.org/10.4037/ccn2013518
[17]
Kawale, M.A., Keche, P.N., Gawarle, S.H. et al. (2017) A Prospective Study of Complications of Tracheostomy and Management in Tertiary Care Hospital in Rural area. International Journal of Otorhinolaryngology and Head and Neck Surgery, 3, 687-692. https://doi.org/10.18203/issn.2454-5929.ijohns20173048
[18]
Khan, R., Akber, N., Hyder, H.S. and Tirmizey, M.A. (2014) Complications of Emergency Tracheostomy. Annals of Punjab Medical College, 8, 6-10.
[19]
Goldenberg, D., Ari, E.G., Golz, A., et al. (2000) Tracheotomy Complications: A Retrospective Study of 1130 Cases. Otolaryngology-Head and Neck Surgery, 123, 495-500. https://doi.org/10.1067/mhn.2000.105714
[20]
Karuga, C.G. (2011) Risk Factors for Early Complications of Tracheostomies at Kenyatta National Hospital. 1-76. https://www.ajol.info/index.php/ecajs/article/view/76495
[21]
Ali, M.A. and Ibrahim, I.A. (2016) Five-Years Experience with Tracheostomy at ENT-Khartoum Teaching Hospital in Sudan. Merit Research Journal of Medicine and Medical Sciences, 4, 92-97.
[22]
Pal, P., Sood, A.S. and Singla, S. (2018) Early Complications of Tracheostomy: A Study on 100 Patients at a Single Tertiary Care Centre. International Journal of Otorhinolaryngology and Head and Neck Surgery, 4, 217-221. https://doi.org/10.18203/issn.2454-5929.ijohns20175628
[23]
Munir, I., Iqbal, S.M. and Ali, S.A. (2012) Open Surgical Tracheostomy and Complications. Abstract. Pakistan Journal of Surgery, 28, 217-221.
[24]
Scurry, W.C. and Mcginn, J.D. (2007) Operative Tracheotomy. Operative Techniques in Otolaryngology, 18, 85-89 https://doi.org/10.1016/j.otot.2007.05.003
[25]
Appiah-thompson, P. (2017) Tracheostomy—The Korle Bu Teaching Hospital Experience. World Journal of Pharmaceutical and Medical Research, 3, 40-55.
[26]
Charles, N. and Mukara, K.B. (2018) Indications and Immediate Outcomes of Tracheostomy in Rwanda. Annals of African Surgery, 15, 52-56. https://doi.org/10.4314/aas.v15i2.4
