Tracheostomy vs. Delayed Extubation in Head and Neck Reconstruction: A Meta-Analysis

Area of Science:

• Head and Neck Surgery
• Critical Care Medicine
• Otolaryngology

Background:

• High-volume centers are exploring delayed extubation (DE) as an alternative to tracheostomy in head and neck reconstruction.
• This strategy aims to manage pharyngolaryngeal edema and ensure ventilation.
• Evidence synthesis on DE versus tracheostomy is limited.

Purpose of the Study:

• To conduct the largest systematic review and meta-analysis comparing delayed extubation (DE) with tracheostomy.
• To evaluate effectiveness and outcomes in patients undergoing head and neck reconstruction.

Main Methods:

• Systematic review of PubMed, Embase, and Scopus databases.
• JBI methodology for systematic reviews of effectiveness.
• Meta-analysis using Mantel-Haenszel method with risk ratios and 95% confidence intervals.

Main Results:

• Delayed extubation (DE) was associated with shorter hospital (12.25 days) and ICU (1.47 days) stays compared to tracheostomy.
• Meta-analysis showed significantly lower risk of airway complications (RR 4.14) and flap complications (RR 8.19) with DE.
• Overall survival (95.7%) and disease-free survival (89.1%) were higher in the DE cohort.

Conclusions:

• Tracheostomy is not always necessary and carries risks, necessitating shared decision-making.
• Delayed extubation (DE) is a viable option for select head and neck reconstruction patients.
• Further randomized controlled trials are needed to confirm these findings.