Predictors of Failed and Delayed Decannulation after Head and Neck Surgery

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Surgical Oncology

Background:

• Head and neck cancer resection with free tissue transfer reconstruction often requires tracheostomy.
• Predicting outcomes such as failed decannulation (FD) and delayed decannulation (DD) is critical for patient management.

Purpose of the Study:

• To identify variables predicting failed decannulation (FD), delayed decannulation (DD), and time to decannulation after head and neck cancer surgery.
• To inform clinical practice and patient counseling regarding decannulation risks.

Main Methods:

• Retrospective case series with chart review of 108 patients who underwent head and neck cancer resection and tracheostomy.
• Analysis included preoperative, cancer-related, and surgical variables.
• Univariate and multivariate logistic and Cox regression analyses were employed to identify predictors of FD, DD, and time to decannulation.

Main Results:

• Total glossectomy, anterolateral thigh flap reconstruction, and current smoking were independent predictors of FD and longer time to decannulation.
• Advanced cancer stage, total glossectomy, anterolateral thigh flap reconstruction, and smoking were associated with FD in univariate analysis.
• 16% of patients experienced FD, and 26% experienced DD.

Conclusions:

• Patients with total glossectomy defects and active smokers are at significantly higher risk for failed or delayed decannulation.
• Implementing robust smoking cessation programs and counseling patients on risk factors are essential.
• These findings aid in optimizing patient selection for reconstructive procedures and managing decannulation.