Percutaneous versus open tracheostomy: comparison of procedures and surgical site infections

Tracheostomy is one of the most common procedures performed in trauma patients in the intensive care unit (ICU). Few studies have evaluated the incidence of surgical site infections (SSIs) specifically in a trauma population. Our objective was to compare the incidence of SSI after open versus percutaneous tracheostomy and to discern whether there were any differences in outcome.

A prospective single-institution study was conducted on 640 patients admitted to the ICU over eight years who underwent tracheostomy. Age, gender, race, admission Injury Severity Score (ISS) and Acute Physiology and Chronic Health Evaluation (APACHE) II score, and mechanism of injury were obtained. The majority of patients were male (56.1%) and white (62.5%) with a mean age of 43.2 ± 20.2 years, ISS of 30.7 ± 13.2 points, and APACHE score of 13.3 ± 6.3 points. The majority of patients were admitted for blunt trauma (85.1%). The outcome was measured by hospital (HLOS) and ICU (ILOS) lengths of stay, duration of mechanical ventilation, infection rate, and mortality rate.

A total of 330 open and 310 percutaneous tracheostomies were performed. A total of 36 SSIs (5.3%) were found. Patients who underwent percutaneous tracheostomy had a statistically significantly lower rate of SSI (3.4%) than the open surgery group (7%) (p=0.04). There was no difference in HLOS, ILOS, ventilator days, or mortality rate.

To our knowledge, this is the largest study of the benefit of percutaneous tracheostomy in a critically injured trauma population. The risk of SSI is significantly lower after percutaneous than open tracheostomy.