Meta-analysis comparison of open versus percutaneous tracheostomy

Area of Science:

• Medical procedures
• Surgical techniques
• Critical care medicine

Background:

• Open and percutaneous tracheostomy methods have been studied for complications and cost-effectiveness.
• Previous studies lacked sufficient power to definitively determine a superior method.

Purpose of the Study:

• To compare complication rates of open versus percutaneous tracheostomy using meta-analysis of prospective, randomized-controlled trials.
• To analyze cost-effectiveness and procedure length for both tracheostomy methods.

Main Methods:

• Meta-analysis of 15 prospective, randomized-controlled trials involving nearly 1,000 patients.
• Extraction of demographic data, complications, case length, and cost-effectiveness.
• Calculation of pooled odds ratios (OR) with confidence intervals (CI), subgroup analyses, and meta-regression.

Main Results:

• Percutaneous tracheostomy showed significantly fewer wound infections (OR 0.37) and unfavorable scarring (OR 0.44).
• Open tracheostomy had significantly higher rates of decannulation/obstruction (OR 2.79).
• No significant differences were found for false passage, hemorrhage, subglottic stenosis, or death, though overall complications trended towards percutaneous. Percutaneous procedures were shorter by 4.6 minutes and less costly by ~$456 USD.

Conclusions:

• A trend suggests fewer overall complications with percutaneous tracheostomy techniques.
• Percutaneous tracheostomy is more cost-effective and feasible for bedside, nonsurgical operations.