Tracheotomy: changing indications and a review of 1,130 cases

Tracheotomy is one of the oldest known operations, dating back to ancient Egypt and India some 3000 years ago. The indications for tracheotomy have changed and expanded during the twentieth century. Today, owing to advancements in intensive care and the widespread use of mechanical ventilation, tracheotomy is one of the most commonly performed surgical procedures and is encountered on a regular basis by hospital physicians in all fields. We present one of the largest series of consecutive tracheotomies spanning one decade. We review and discuss the modern indications for tracheotomy and emphasize the changes in these indications over the past century.

A retrospective study of 1,130 consecutive tracheotomies performed over one decade is presented. We studied the indications for surgery, the complications and mortality rate, and the various hospital departments requiring tracheotomies.

A total of 1,130 tracheotomies were performed: 859 to assist in mechanical ventilation, 124 as an adjunct to head and neck or chest surgery, and 68 to relieve upper airway obstruction. Major complications occurred in 49 of the cases, and there were 8 deaths directly attributed to the tracheotomies. The most common complication was tracheal stenosis, occurring in 21 cases. Hemorrhage was the second most common complication, occurring in 9 cases.

Tracheotomy, once used almost exclusively to bypass upper airway obstruction, is now a very common elective therapeutic procedure used mostly to facilitate prolonged intubation and ventilation of the critically ill. Today tracheotomy is not and should not be an emergency procedure owing to the huge complication and mortality rate of emergency tracheotomy and the existence of alternative routes to obtain immediate airway control in the acutely obstructed upper airway.