Tracheotomy complications: A retrospective study of 1130 cases

BACKGROUND: Tracheotomy is one of the most frequently performed surgical pr ocedures in the critically ill patient. It is frequently performed as an el ective therapeutic procedure and only rarely as an emergency procedure. Com plications occur in 5% to 40% of tracheotomies depending on study design, p atient follow-up, and the definition of the different complications. The mo rtality rate of tracheotomy is less than 2%. Numerous studies demonstrate a greater complication and mortality rate in emergency situations, in severe ly ill patients, and in small children. METHODS: A retrospective study of 1130 consecutive tracheotomies performed during 1 decade (January 1987 through December 1996) is presented. We studi ed the indications for surgery, the major complications of tracheotomy, and their treatment and outcome. We also noted the overall mortality rate and the specific complications that led to these deaths. RESULTS: In total, 1130 tracheotomies were performed. Major complications o ccurred in 49 of the cases, and 8 deaths were directly attributed to the tr acheotomy. The most common complication was tracheal stenosis, which occurr ed in 21 cases. Hemorrhage was the second most common complication, which o ccurred in 9 cases. CONCLUSION: This is one of the largest series of consecutive tracheotomies compiled. We found a relatively low overall complication and mortality rate compared with other large series. Tracheal stenosis was the most common co mplication in contrast to other series. Our opinion is that this may reflec t tracheal damage originally caused by prolonged intubation before the trac heotomy. We believe that all other complications of tracheotomy may be prev ented or minimized by careful surgical technique and postoperative tracheot omy care.