P-66322411-77 - Indication for temporary tracheotomy in microvascular reconstructions in the head and neck area

Abstract

<h3>Purpose</h3> Different airway management options in microvascular head and neck reconstructive surgery are being widely discussed. To prevent overtreatment, it is important to carefully weigh intubation versus tracheotomy. The aim of this study was to establish a guideline that helps in the decision-making process. <h3>Methods</h3> Medical records of patients treated between January 2016 and December 2018 were reviewed. Only non- primarily tracheotomised patients were included in this study. The cohort was divided into patients with and without airways complication during hospitalization. The data collected include age, gender, diagnosis, ASA score, Mallampati classification, localisation of reconstruction, type of flap, extend of neck dissection, comorbidities, days spent in the intensive care unit, length of hospitalization, loss and administration of fluid and blood during surgery, and reason for airways complication. Statistical analyses were performed using IBM SPSS 27. <h3>Results</h3> 64 case files were reviewed with 9 patients experiencing airway complications. Patients with intraoral or multiple locations of pathologies were more likely to suffer from airway complication. Analysis of the patient group with complications showed that 77.8% had undergone voluminous reconstruction using, for instance, fibular flaps. Nicotine and alcohol consumption also seemed to increase the risk. <h3>Conclusions</h3> To confirm these findings, further prospective studies with a greater patient cohort need to be conducted whereby flap size should be given special consideration when deciding on the appropriate airway management.