Open Versus Percutaneous Tracheostomy in Patients With Liver Cirrhosis: Analysis of a Nationwide Database

Evidence for the appropriate type of tracheostomy in patients with liver cirrhosis is lacking. A retrospective analysis of the National Inpatient Sample (NIS) was performed.

Adult patients with liver cirrhosis undergoing tracheostomy while on mechanical ventilation for respiratory failure were abstracted from the NIS database between 2016 and 2018 and analyzed. Patients were divided according to the type of tracheostomy performed into open tracheostomy (OT) and percutaneous tracheostomy (PT) and analyzed for tracheostomy complications and clinical outcomes. Subgroup analyses were performed for patients with compensated cirrhosis (CC) and decompensated cirrhosis (DC).

A total of 44745 cases were analyzed. The OT group had a higher rate of overall tracheostomy-related complications (TC) (5.1% vs 3.5%; P < .001), hemorrhage from the tracheostomy site (HC) (2.7% vs 1.8%; P = .008) and other complications (OC) (2.7% vs 1.8%, P = .003). Multivariate analyses showed that OT was a risk factor for TC (Adjusted odds ratio (AOR) 1.50, P < .001), HC (AOR 1.46, P = .009), and OC (AOR 1.55, P = .003). Similarly, in subgroup analyses, OT cases, compared to PT, were associated with increased TC (5.0% vs 3.4%, P < .001), HC (2.7% vs 1.7%, P = .002) and OC (2.6% vs 1.8%, P = .020) in DC patients.

OT is associated with a significantly higher rate of complications. OT was also associated with more complications in DC patients, suggesting that a percutaneous approach may be the best option in cirrhotic patients when feasible.