Percutaneous versus surgical tracheotomy: an updated meta-analysis

Area of Science:

• Critical Care Medicine
• Surgical Innovation
• Evidence-Based Practice

Background:

• Tracheotomy is a common procedure for airway management.
• Percutaneous dilational tracheotomy (PDT) and surgical tracheotomy (ST) are two primary methods.
• Understanding comparative outcomes is crucial for clinical decision-making.

Purpose of the Study:

• To conduct an updated meta-analysis comparing complication rates, procedure times, and costs.
• To evaluate differences between percutaneous dilational tracheotomy (PDT), operating room surgical tracheotomy (ST), and bedside surgical tracheotomy (BST).

Main Methods:

• Meta-analysis utilizing a Mantel-Haenszel fixed effects model.
• Inclusion of prospective and randomized trials comparing ST with PDT from 1999 to present.
• Analysis of outcomes including mortality, early and late complications, procedure times, and cost.

Main Results:

• PDT showed significantly more minor early complications compared to ST (OR, 1.6) and BST (OR, 4.66).
• No significant difference in late serious complications was found between PDT and ST (OR, 1.39).
• PDT was significantly faster than ST (OR, 0.51), with BST and PDT having similar, lower costs than ST.

Conclusions:

• PDT, while faster than ST, is associated with increased early complications compared to open tracheotomy.
• Long-term complication data for PDT versus ST are limited but appear comparable.
• A collaborative approach between surgeons and critical care specialists is vital for selecting the optimal tracheotomy technique.