Factors Affecting Prolonged Intubation and Difficult Airway After Odontogenic Infection

Odontogenic infections can rapidly become life-threatening as a result of airway obstruction. This is further complicated by severe trismus and postoperative edema.

The purpose of the study was to estimate the frequency and identify risk factors associated with the need for prolonged and advanced airway management preoperatively or postoperatively in patients with severe odontogenic infections.

A retrospective cohort study was designed to evaluate risk factors associated with difficult airways in patients with odontogenic infections. Included subjects had presented to the University of Illinois Health Hospital Emergency Department with a confirmed odontogenic infection requiring incision and drainage (I&D) in the operating room between the years of 2005 and 2024. Subjects were excluded for incomplete records or if they had undergone I&D elsewhere.

The predictor variable was composed of a heterogenous set of risk factors such as age, sex, alcohol use, tobacco use, hypertension, diabetes status, asthma, coronary artery disease, American Society of Anesthesiologist status, leukocytosis, immunocompromise, and pharyngeal space infection.

The main outcome variable was the need for advanced airway management perioperatively via an endotracheal tube or tracheostomy. Secondary outcomes were the frequency of need for advanced airway management, length of hospital stay in days, admission to the intensive care unit, total duration of intubation in days, need for a secondary I&D, need for surgical airway management with a tracheostomy, and patients' length of stay in the hospital.

Not Applicable.

The data were analyzed using the χ2, t test, and regression analysis, with statistical significance set at P < .05.

After application of the inclusion and exclusion criteria, 349 subjects were included in this study. The final dataset included 187 (54%) males and 162 (46%) females, with a mean age of 40.9 ± 18.8 years (range 3 to 89 years). Of the 349 subjects, 36 (10.3%) required intubation for their odontogenic infection in the perioperative period. The mean length of intubation was 4.0 ± 7.8 days, and the median was 2 days. Tracheostomy was required in 3 subjects (0.9%). Subjects with prolonged intubation had a longer mean length of stay, 7.6 ± 8.1 days versus 3.6 ± 4.6 days (P < .00001). There were statistically significant differences between the prolonged intubation group and the extubated group regarding admission leukocytosis (75.0 vs 55.6%, P = .03), immunocompromised status (22.2 vs 10.2%, P = .03), and pharyngeal space involvement on CT (38.9 vs 14.7%, P = .0003). Asthma was not a statistically significant risk factor for prolonged intubation. Regression analysis found that only pharyngeal space infection (P < .004) and immunocompromised status (0.007) were associated with risk for prolonged intubation.

In conclusion, airway compromise in the perioperative period of an I&D procedure of an odontogenic infection necessitating prolonged intubation occurred at a frequency of 10.3% in our patient population. Prolonged intubation was associated with immunocompromised status and infection in the pharyngeal space on CT. Prolonged intubation resulted in a statistically significant increase in length of hospital stay.

Level III (retrospective cohort; no randomization; chart review across 19 years).