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Safety of surgical tracheostomy under continued antithrombotic therapy: A retrospective cohort study

Takayuki Sugaya1, Rumi Ueha1,2, Taku Sato1

  • 1Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.

Clinical Otolaryngology : Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
|September 16, 2021
PubMed

Insights

Surgical tracheostomy (ST) can be safely performed with continued antithrombotic therapy (CAT), showing no increased risk of complications. However, surgeons must be cautious with ST under local anesthesia or for airway emergencies.

Area of Science:

  • Otolaryngology
  • Surgical Procedures
  • Cardiology

Background:

  • Surgical tracheostomy (ST) management guidelines exist, but performing ST under continued antithrombotic therapy (CAT) presents challenges.
  • Investigating risk factors for ST complications is crucial, particularly concerning CAT application.

Purpose of the Study:

  • To investigate the risk factors for complications after surgical tracheostomy (ST).
  • To focus on the application of continued antithrombotic therapy (CAT) during ST.

Main Methods:

  • Retrospective cohort study.
  • Analysis of medical records from 2009 to 2020 at a single center.
  • Inclusion of patients who underwent ST, with a focus on those on CAT.

Main Results:

  • No statistically significant differences in bleeding, infection, or subcutaneous emphysema were observed between patients on CAT and antithrombotic-naïve patients.
  • Patients on CAT showed longer activated partial thromboplastin time and higher prothrombin time-international normalized ratio.
  • ST under local anesthesia and ST for airway emergencies were identified as significant risk factors for early postoperative complications.

Conclusions:

  • Surgical tracheostomy (ST) can be safely performed under continued antithrombotic therapy (CAT) without an increased risk of postoperative complications.
  • Surgeons should exercise increased caution for early complications in ST performed under local anesthesia without intubation or in cases of airway emergencies.
Abstract

Keywords:
antithrombotic drugscomplicationlocal anaesthesiarisk factorsurgical tracheostomy

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