Discharge destination following elective and emergency surgical tracheostomies in head and neck cancer patients

Abstract

Objectives: Tracheostomy in the setting of head and neck cancer may be performed either electively for prophylactic airway protection in an ablative procedure, or as an emergency due to impending airway obstruction in the setting of an obstructing upper aerodigestive tract malignancy. Tracheostomy care has biopsychosocial implications, which may require a higher level of care from carers, post-acute care, or placement into care facilities. Existing database studies have largely excluded patients with a history of head and neck cancer. This study aims to examine and compare discharge destinations for head and neck cancer patients requiring either elective or emergency surgical tracheostomies. Methods: Retrospective cohort study (January 2010-December 2019) of adult head and neck cancer patients undergoing surgical tracheostomy in a tertiary Australian hospital network. Primary outcome was discharge destination. Secondary outcomes were mortality, morbidity, and decannulation timing. Results: Of 188 patients (47 emergency, 141 elective), 83.0% returned to their pre-morbid accommodation, either directly home (54.6%), or with additional community-based services (27.7%). There was a significant difference in post-discharge destination (p=0.012). Emergency patients were less likely to return home compared to elective patients (OR 0.76, 95%CI 0.32-1.79), and more likely to require additional supports on discharge(67.6%) compared to elective(41.9%) patients. However, these outcomes did not demonstrate statistical significance. Emergency tracheostomy patients were at higher risk of permanent tracheostomy, unplanned readmission within 30 days, and longer time to successful decannulation. Conclusion: Emergency tracheostomy patients are likely to return to their pre-morbid place of residence but may require additional support.