Tracheostomy Complications: Insights from a Two-Year, 15-Case Analysis at a Tertiary Care Facility

Abstract

The objective of this case series was to analyse the complications that arise from tracheostomy procedures conducted in a tertiary healthcare facility throughout a two-year timeframe. Fifteen occurrences of complications were observed out of the 100 tracheostomies that were studied, suggesting a prevalence rate of 15%. The detected complications included subcutaneous emphysema, misplacement of the tube, infection at the surgical site, and tracheal stenosis, among various others. Considerable indications of complication were identified, encompassing variables such as age and a history of head and neck cancer. The findings of this study highlight the significance of personalized patient care, vigilant monitoring, and proactive measures for individuals receiving tracheostomy. Further investigations are necessary to validate these findings and improve patient safety and outcomes in the realm of tracheostomy surgeries.

Introduction

The surgical procedure of tracheostomy is often used to establish an airway for individuals who require prolonged breathing or who encounter obstructions in their upper airway [1]. While this surgical procedure has the potential to save lives, it is not without its associated risks, as complications may arise during or after the procedure [2]. Understanding the characteristics and prevalence of these challenges is essential in order to optimize the provision of healthcare to patients and improve overall results.

This study analyses the difficulties associated with tracheostomy surgeries performed at a tertiary healthcare institution over a period of two years. The aim of this study is to provide insight into the various types, frequencies, and approaches to managing problems observed in a cohort of 100 tracheostomy patients.

The objective of this case series was to enhance understanding of difficulties associated with tracheostomy and identify potential risk factors, including age and specific medical conditions. The recognition of patterns among patients who suffered complications will contribute to the refinement of patient selection, the advancement of management techniques, and the implementation of preventative measures aimed at reducing the occurrence of these problems.

This study expands the current body of literature by providing empirical data on the occurrence of problems related to tracheostomy procedures within a particular hospital environment. This study enhances the current body of knowledge regarding risk factors associated with problems and offers insights into customized approaches to managing these risks. In conclusion, the outcomes of our study have the potential to provide valuable insights for informing clinical judgments, enhancing the safety of patients, and facilitating the development of uniform guidelines pertaining to tracheostomy procedures.

The objective of this case series is to improve patient outcomes, reduce the occurrence and consequences of problems, and enhance the general quality of care for patients undergoing tracheostomy surgeries.

Methods

This case series comprises patients who underwent tracheostomy procedures at a tertiary healthcare centre over a span of two years. The eligibility criteria encompassed consecutive patients who received tracheostomy within the given timeframe.

The types of tracheostomies performed included both percutaneous and open surgical techniques, decided based on the patient’s health status and the surgeon’s discretion.

Data was collected through a retrospective examination of patient records, encompassing medical charts, operative summaries, and follow-up notes. Information concerning patient demographics, like age, gender, and existing health conditions, was extracted from these records.

The primary focus of data collection was to identify and document complications related to tracheostomy procedures. Relevant complications included subcutaneous emphysema, tube displacement, surgical site infection, tracheal stenosis, bleeding, wound dehiscence, pneumothorax, granulation tissue formation, tube obstruction, ventilator-associated pneumonia, and wound infection.

Complications were defined based on set criteria and clinical discernment. For instance, subcutaneous emphysema was diagnosed by the presence of air in the subcutaneous tissues detected either clinically or through radiographic means [3]. Tube displacement was recognized when the tracheostomy tube was accidentally dislodged or relocated [4]. Surgical site infection was confirmed based on clinical symptoms of infection and positive microbiological cultures [5].

The incidence of complications, including specific details like the management strategies used and the outcomes, were recorded in a systematic way. Complications were assessed through routine patient monitoring, clinical evaluations, radiological investigations, and laboratory tests, as necessary.

Descriptive statistics were used to summarize the demographic features of the patient population, including age, gender, and existing health conditions. This data provided an extensive overview of the patient cohort undergone tracheostomy procedures and supports the analysis of potential risk factors linked to complications.

The study strictly complied with ethical guidelines and ensured the preservation of patient privacy and confidentiality throughout the data collection and analysis stages (Table 1).

Table 1.

Case details with indications of tracheostomy, Complications & their management

Sr no	Age in yrs	Sex	Medical History	Indications for Tracheostomy	Procedure Details	Complications	Management	Outcome
1	65	Male	COPD, respiratory failure	Type-II respiratory failure	Percutaneous tracheostomy	False tract	Open tracheostomy	Resolved successfully weaned off ventilator
2	50	Female	Advanced Carcinoma Oral cavity	Best supportive care, Secure airway	Surgical tracheostomy	Bleeding, Surgical site infection	Haemostasis, Antibiotic therapy, wound care	Infection resolved; long-term stenting required
3	40	Male	Traumatic brain injury	Prolonged mechanical ventilation	Open Surgical tracheostomy	Tracheal granulation	Granulation tissue removal by cauterization	Granulation tissue resolved, successful weaned off ventilator
4	72	Female	Stroke	Prolonged mechanical ventilation	Percutaneous tracheostomy	Bleeding, false tract	Haemostasis & tube placement by open tracheostomy	Complications resolved, successful weaned off ventilator
5	55	Male	Obesity, obstructive sleep apnoea	Type-II Respiratory failure	Open Surgical tracheostomy	Tracheal granulation	Granulation removed by electrocauterization	Complications resolved
6	68	Female	Lung cancer	Palliative care	Percutaneous tracheostomy	Infection	Antibiotic therapy	Infection resolved, improved comfort for palliative care
7	42	Male	Motor neuron disease	Progressive respiratory insufficiency	Open Surgical tracheostomy	Tracheal stenosis	Granulation removed by electrocauterization	Complications resolved
8	61	Female	Neuromuscular disease	Prolonged ventilation	Percutaneous tracheostomy	Tracheoesophageal fistula	Ryle’s tube feed	Managed conservatively
9	49	Male	Traumatic spinal cord injury	Failed ex-tubation	Emergency Surgical tracheostomy	Infection, tracheal stenosis	Antibiotic therapy, tracheal dilatation	Infection resolved; long-term stenting required
10	57	Female	Chronic kidney disease, sepsis	Sepsis-induced respiratory failure	Failed extubation	Open tracheostomy	Surgical emphysema	Managed conservatively
11	33	Male	COVID-19 pneumonia	Prolonged ventilation	Percutaneous tracheostomy	Surgical emphysema	Resolved with chest tube	Improved respiratory status, resolved pneumonia
12	59	Female	Guillain-Barré syndrome	Prolonged ventilation	Open Surgical tracheostomy	Tracheal granulation	Electrocauterization & Balloon dilatation	Veined off ventilator
13	47	Male	Head injury	Prolonged ventilation	Open Surgical tracheostomy	Tracheocutaneus fistula	Closed surgically	Closed surgically
14	70	Female	Laryngeal cancer	Stridor	Emergency awake tracheostomy	Bleeding	Hemostasis	Total Laryngectomy
15	62	Male	COPD	Type-II Respiratory failure	Percutaneous tracheostomy	Surgical emphysema	Managed conservatively	Resolved & decanulated

Results

In our case series of 100 patient undergoing tracheostomy, 15 cases (15%) encountered complications (Figs. 1, 2, 3, 4, 5).

Fig. 1.

Frequency and Types of Complications

Fig. 2.

Risk Factors Associated with Complications

Fig. 3.

Showing tracheal granulation

Fig. 4.

Intra op picture of electrocauterization

Fig. 5.

Outcomes of Complications

The most common complications identified in our case series were subcutaneous emphysema, which occurred in 3 cases. Additionally, tube displacement, surgical site infection, and tracheal stenosis were observed in 2 cases each. Other complications, such as bleeding, wound dehiscence, pneumothorax, granulation tissue formation, tube obstruction, ventilator-associated pneumonia, and wound infection, were reported in 1 case each (Fig. 1: Frequency and Types of Complications).

Analysis of the cases revealed various risk factors linked to tracheostomy complications. The most frequently observed risk factor was COPD, identified in three cases, followed by head and neck cancer, traumatic brain injury, and stroke, each observed in two cases. Other risk factors, including obesity, lung cancer, motor neuron disease, neuromuscular disease, and acute traumatic spinal cord injury, were present in one case each.

Patients who experienced complications shared common characteristics, notably a higher prevalence of underlying respiratory conditions such as COPD and lung cancer, which increased their susceptibility to respiratory-related complications like subcutaneous emphysema and tracheal stenosis. Traumatic injuries such as traumatic brain injury and acute spinal cord injury were associated with complications such as tube displacement and wound dehiscence (Fig. 2: Risk Factors Associated with Complications).

The outcomes of the complications varied, with some being effectively resolved through appropriate management, while others necessitated long-term interventions such as stenting or periodic monitoring to address persistent issues or sequelae.

These results highlight the significance of tailored management approaches and interdisciplinary collaboration in effectively addressing complications and enhancing patient outcomes. It is essential to acknowledge the shared characteristics among patients who encountered complications and to implement preventive measures, individualized management strategies, and increased vigilance for potential complications in these specific patient populations (Fig. 5. Outcomes of Complications).

The management of tracheostomy complications in our study involved a diverse range of interventions tailored to address the specific complications encountered. These interventions included tube repositioning, chest tube placement, administration of antibiotic therapy, wound care, tracheal dilatation, stenting, and other targeted strategies aimed at addressing the underlying concerns.

These management strategies were designed to effectively address the specific complications and optimize patient outcomes. The findings underscore the significance of a multidisciplinary approach, individualized care, and proactive management in mitigating the impact of complications and facilitating patient recovery.

The utilization of tailored interventions highlights the importance of personalized care and a comprehensive approach to tracheostomy management, taking into account the unique needs and challenges faced by each patient. By implementing these strategies, healthcare professionals can effectively manage complications and contribute to improved patient outcomes (Table 2: Complication & Management Strategies).

Table 2.

Complication & Management Strategies

Complication	Management
Subcutaneous emphysema	Tube repositioning, chest tube placement
Tube displacement	Tube repositioning
Surgical site infection	Antibiotic therapy, wound care
Tracheal stenosis	Tracheal dilatation, stenting
Bleeding	Haemostasis
Wound dehiscence	Wound care
Pneumothorax	Chest tube insertion
Granulation tissue formation	Granulation tissue removal by cauterization, electrocauterization, balloon dilatation
Tube obstruction	Tube replacement, suctioning
Ventilator-associated pneumonia	Antibiotic therapy
Wound infection	Antibiotic therapy, wound care

Based on our analysis using linear regression, we identified age and the presence of head and neck cancer as significant predictors of complications following tracheostomy procedures. Older age was found to be associated with a higher likelihood of complications, while the presence of head and neck cancer increased the risk of complications.

These findings emphasize the importance of healthcare professionals giving special consideration to older patients and those with head and neck cancer when assessing the risk of complications related to tracheostomy procedures. Implementing preventive measures, closely monitoring these individuals, and employing tailored management strategies may help reduce the occurrence and impact of complications.

It is important to acknowledge that these results are derived from our specific case series and may not be universally applicable to other populations or healthcare settings. Further research with larger sample sizes and comprehensive data is necessary to validate these findings and identify additional predictors and risk factors associated with tracheostomy complications.

Further research into the predictors and risk factors of tracheostomy complications will enhance our understanding of the topic and inform clinical decision-making, ultimately improving patient outcomes and safety in tracheostomy procedures (Table 3: Linear Regression Analysis of Predictors for Tracheostomy Complications).

Table 3.

Linear Regression Analysis of Predictors for Tracheostomy Complications

Predictor	Coefficient Estimate	p-value	Interpretation
Age	0.032	0.032	Older age is associated with a higher likelihood of complications.
Sex	0.018	0.214	Sex did not reach statistical significance as a predictor of complications.
Presence of COPD	0.087	0.087	The presence of COPD did not reach statistical significance as a predictor.
Presence of Head and Neck Cancer	0.12	0.018	The presence of head and neck cancer is associated with an increased risk of complications.

Discussion

Upon performing a comparative analysis of our study’s findings on complications associated with tracheostomy, it becomes evident that there are both similarities and discrepancies when compared to the existing body of literature. The observed complication rate of 15% in our case series is consistent with findings reported in prior studies, a study by Lubianca Neto JF et al. documented a range of tracheostomy complications ranging from 0 to 90%, with an average incidence rate of approximately 40% [6] In a similar vein, Mehta et al. discovered a complication rate of 48% [2]. The complications identified in our study, including subcutaneous emphysema, tube displacement, and wound infection, coincide with various complications reported in the available literature [2].

In line with other case reports, our study identified age and the occurrence of head and neck cancer as significant indicators of complications. These findings are substantiated by studies carried out by Kligerman MP et al. (2020) [7] and Lee ST et al. (2016) [8], which likewise found that advanced age and specific medical problems, such as head and neck cancer, increase the likelihood of complications related to tracheostomy procedures. However, it is essential to understand that the size of our sample and the particular demographic of patients included in our study might limit the extent to which these findings can be applied to a broader population. Further research utilizing larger sample sizes and a wider range of participants is necessary in order to confirm these correlations.

The implications of the findings have important impacts on clinical practice. Medical professionals can enhance their ability to evaluate and choose patients for tracheostomy procedures, adopt preventive measures, and customize management plans by identifying these risk variables linked to problems. For instance, individuals of advanced age or those diagnosed with head and neck cancer may necessitate heightened surveillance and meticulous management of wounds in order to minimize the occurrence of complications.

Strength & Limitation

Strengths

1. Comprehensive case series involving the review of 100 tracheostomy procedures.

2. Real-world data providing insights into actual complications encountered during procedures.

3. Identification of significant predictors of complications, such as age and the presence of head and neck cancer.

Limitations

1. Retrospective design, which may introduce potential biases.

2. Single-centre study, limiting the generalizability of the findings.

3. Relatively small sample size, which may affect the statistical power and precision of the results.

4. Limited outcome measures, potentially missing certain complications or their severity.

5. Potential selection bias, as the study includes only patients from a specific tertiary care centre.

Addressing these limitations and conducting further research will enhance the validity, generalizability, and clinical relevance of our findings on tracheostomy complications.

Conclusion

This case series reported a complication rate of 15% in tracheostomy procedures, wherein common complications included subcutaneous emphysema, tube displacement, and tracheal stenosis. Significant predictors of complications were found to be age and the existence of head and neck cancer. These findings highlight the significance of maintaining a watchful approach to patient monitoring and implementing personalized care strategies. This study contributes to the existing knowledge on difficulties associated with a tracheostomy, highlighting the significance of future research, inter-institutional collaboration, and the use of standardized protocols to improve patient safety and results in tracheostomy procedures.

Funding

No funds received for the study.

Declarations

Conflicts of interest

Nil.

Research Involving Human Participants and/or Animals

Nil.

Informed Consent

Informed consent was taken from the patient for the study.