[Percutaneous dilatative tracheostomy versus conventional surgical tracheostomy: a retrospective trial]

In this retrospective study we compared endoscopically controlled percutaneous dilatative tracheostomies (PDT) with conventional surgical tracheostomies as a bedside procedure and in the operating theatre.

Between 1998 and 2000 we performed 360 tracheostomies electively, 152 in PDT-technique (42 %) and 208 (58 %) with the conventional procedure. Referring to the PDT-technique 74 % (n = 112) were performed at the bedside and 26 % in the operating theatre. The conventional tracheostomies took place at bedside in 53 % (n = 110) and in the operating theatre in 47 % (n = 98) of the cases. The complications were divided in 5 groups with special interest if the operation took place in the operating theatre or as a bedside procedure.

In general the rate of complications in the PDT group was 33 % (50/152) versus 22 % (46/208) referring to the conventional group. Referring to the PDT group the rate of complications were 35 % (39/112) at the bed site procedure and 28 % (11/40) in the operating theatre. The complication rate for the conventional group was 27 % (30/110) as a bedside procedure versus 16 % (16/98) in the operating theatre. Significant differences were found for the PDT with an increase of tubal obstructions (p = 0.007). For the conventional tracheostomy we found a significant increase of wound infections (p = 0.006). There was significantly higher postoperative hemorrhage if the procedure was done at bed site.

PDT and conventional tracheostomies have different complications. The higher risk of postoperative hemorrhage for bed site procedure has to be considered.