Comparison of postoperative complications in early versus delayed tracheostomy decannulation in patients undergoing oral cancer surgery with microvascular reconstruction

• Published in: British journal of oral & maxillofacial surgery Vol. 61; no. 1; pp. 101 - 106
• Main Authors: Adhikari, Ashim, Noor, Anthony, Mair, Manish, Ho, Joyce, Fuzi, Jordan, Giles, Mitchell, Winters, Ryan, Tan-Gore, Eileen, Cope, Daron, Hoffman, Gary, Eisenberg, Robert
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.01.2023
• Subjects: Carcinoma, Squamous Cell - surgery; Humans; Length of Stay; Mouth Neoplasms - surgery; Oral cancer; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Retrospective Studies; Tracheostomy; Tracheostomy - methods; Oral cancer; Tracheostomy
• ISSN: 0266-4356; 1532-1940
• DOI: 10.1016/j.bjoms.2022.11.285

The purpose of this study was to determine the relationship of early and delayed tracheostomy decannulation protocols on the length of stay, time to oral feeding and incidence of postoperative complications in patients undergoing microvascular reconstruction for oral cancer. A review of all patients who underwent surgical management of oral squamous cell carcinoma (OSCC) over the study period from 01/07/2017 to 31/06/2021 was performed. Patients who underwent elective tracheostomy as part of their microvascular reconstruction were included. Two cohorts were identified based on distinct postoperative tracheostomy decannulation protocols; early (Within 7 days) and delayed (≥7 days). Time to oral feeding, length of stay and complication rates was determined for both groups for statistical analysis. A total of 103 patients with OSCC were included in the study. The overall complication rate was 35.9% and were more likely in node positive patients (53.7% vs 23.2%; p = 0.003) and in cases where the geniohyoid muscle complex was disrupted during tumour resection (66.7% vs 31.9%; p = 0.026). Early decannulation was significantly associated with shorter length of hospital stay (10 days vs 15 days) and earlier removal of nasogastric feeding tubes (7 vs 10 days). There was no difference in the overall complication rate between the two groups (33.3% vs 37.5%; p = 0.833). Early decannulation in appropriately selected patients is recommended as it significantly reduces the length of hospital stay and aids in early resumption of oral intake. Furthermore, this approach is not associated with increased rates of complications.