Analysis of tracheostomy-associated morbidity after operations for head and neck cancer

Tracheostomy is a safe and effective way of securing the airway in patients who have radical resections for head and neck cancer. We audited the morbidity after 265 tracheostomies to identify the risks in relation to head and neck surgery, and to propose recommendations to improve care. Twenty-one tracheostomy-related complications were encountered in 256 patients (8%). Most complications occurred during the early postoperative period (72%). There were no tracheostomy-related deaths. Tracheostomies were retained for a median of 10 days (range 1–160). Delayed extubation was associated with extent of resection [ P = 0.006], site of tumour (floor of mouth and anterior two thirds of tongue [P = 0.02]), and age (<61 years [ P = 0.02]). Patients who were given preoperative radiotherapy were significantly more likely to develop a tracheostomy-related complication (P = 0.03). Patients with a tracheostomy complication were more likely to have other serious complications (P = 0.05) and in these patients there was a risk of delayed extubation (P = 0.06). We conclude that elective tracheostomy is essentially event-free, and most complications occur in the ward.