Objective
Prophylactic tracheostomy was commonly performed in head and neck cancer patients who underwent tumor ablation surgery with free-tissue transfer to avoid postoperative airway compromise. However, whether prophylactic tracheostomy is necessary is still in debate and protocols varies based on surgeon or institutional experience. In this study, we would like to identify possible risk factors associated with postoperative adverse airway events.
Material and Methods
We retrospectively collected head and neck cancer patients who had undergone tumor ablation surgery following immediate free-tissue transfer without prophylactic tracheostomy during 2008 to 2011 in Chang Gung Memorial Hospital. Demographics, oncological status, baseline comorbidities, intra-operative variables and post-operative respiration status were retrieved. Primary outcomes were postoperative adverse airway events including unplanned reintubation or prolonged intubation with tracheostomy. Secondary outcomes were hospital length and related complications. Statistical analysis was carried out to identified variables associated with adverse airway events.
Results
Total 381 patients were identified in this study. Adverse airway events happened in 29 patients (7.6%). In event group, patients were older, and had high percentage of underlying diabetes mellitus and cerebrovascular disease. Distribution of tumor location was significant different between groups. Also, events group had lower preoperative hemoglobin, renal function and albumin level with more intraoperative blood transfusion and segmental mandibulectomy performed. Post-operative respiration file before extubation including rapid shallow breathing index and PaO2/FiO2 ratio was poorer in events group. In multivariate analysis, patient’s age, tumor location, segmental mandibulectomy or not were independent risk factors of postoperative airway adverse events.
Conclusions
In head and neck cancer patients without prophylactic tracheostomy and had undergone tumor ablation surgery with immediate free-tissue transfer. Patient’s age, tumor location and segmental mandibulectomy performed or not are independent risk factors of postoperative adverse airway events.