CT-Based Comparison of Tracheostomy Placement Accuracy: Open Versus Percutaneous Approaches

Area of Science:

• Medical Imaging and Interventional Procedures
• Surgical Techniques and Outcomes
• Patient Safety and Quality Improvement

Background:

• Accurate tracheostomy tube placement is crucial for patient safety and effective ventilation.
• Computed tomography (CT) is a valuable tool for assessing post-procedure stoma accuracy.
• Comparing open surgical tracheostomy (OST) and percutaneous dilational tracheostomy (PDT) placement is essential for optimizing techniques.

Purpose of the Study:

• To compare stoma placement accuracy between open surgical tracheostomy (OST) and percutaneous dilational tracheostomy (PDT) using CT imaging.
• To identify patient-specific and procedural factors associated with high tracheostomy placement.

Main Methods:

• Retrospective review of 503 adult patients who underwent OST or PDT with post-procedure CT.
• Primary outcome: vertical distance from cricoid cartilage to cannula center (mm).
• Multivariate regression analysis to identify predictors of stoma distance and high placement (≤10 mm).

Main Results:

• Mean stoma distance was 12.6 mm; PDT resulted in a slightly shorter distance than OST (p=0.03).
• High placement rates did not differ significantly between OST and PDT (37.1% vs. 31.7%).
• Older age, higher BMI, general surgery team, and larger cannula diameter predicted shorter distances and higher placement; female gender predicted greater distance.

Conclusions:

• Tracheostomy placement accuracy is influenced more by patient factors (age, BMI) and procedural elements (cannula size, surgical team) than by the technique (OST vs. PDT) alone.
• In otolaryngology cases, PDT placement is comparable to OST.
• CT imaging is effective for evaluating tracheostomy placement accuracy and identifying influencing factors.