Complications of emergency and elective tracheostomy: a retrospective study of 150 consecutive cases

The complications associated with 150 consecutive tracheostomies in adults were reviewed. A standard technique was used in all but five operations. The number and type of complications were compared between emergency and elective cases and between local and general anaesthetic cases. Only minor complications were observed. No deaths occurred attributable to the tracheostomy and there were no cases of symptomatic tracheal stenosis. Persistent tracheocutaneous fistulae occurred in five cases, of which four had been in situ for over 6 months, three had a previous tracheostomy and one had received radiotherapy to the region. Two unsightly scars required revision. The authors recommend the use of a simple standard technique with the insertion of a 'rescue' suture. Close postoperative supervision by nursing staff specially trained in the care of tracheostomies is of paramount importance in avoiding hypoxic complications secondary to displacement of the tracheostomy tube. Recent moves away from tracheostomy should only continue if the alternatives prove to have an even lower complication rate.