Neurosurgeons performing tracheostomies- maintaining proficiency in the modern era

Tracheostomy is a basic surgical procedure that most surgeons, regardless of specialty, learn early in their training. With improvements in intensive care medicine, the number of neurosurgical patients requiring tracheostomy has declined. As neurosurgeons advance in their training, familiarity with airway management declines and falls under the domain of other specialties. Because neurosurgeons still manage critically ill patients, they often defer the airway management to other specialists. In many institutions, neurosurgeons no longer perform tracheostomies. The purpose of this study was to evaluate complications and outcomes following tracheostomies performed by neurosurgeons.

We reviewed a database of all neurosurgical procedures performed at a single institution from 9/2007 to 2/2017. We reviewed the operative and medical records of patients whose tracheostomies were performed by a neurosurgeon.

Neurosurgeons performed 72 tracheostomies over the study period. All the procedures were done in an operating room using traditional open technique. Four patients had previous tracheostomy. Five patients were on dual antiplatelet therapy. The procedure was successful in all patients. There were no immediate complications in any patient. One patient required revision for development of tracheo-cutaneous fistula.

Tracheostomies can be performed safely by neurosurgeons in this era of sub-specialization. There is a renewed interest in maintaining critical care proficiency in neurosurgery. Airway management is an important part of this skill-set. Neurosurgeons manage patients with brain injuries, cranial nerve deficits, and cervical spine injuries, Consequently, learning how to establish a surgical airway remains necessary in neurosurgical training.