Abstract B36: Avoidance of “prophylactic” tracheostomy in free-flap reconstruction surgery of the head and neck: Implications for postoperative outcomes and patient quality of life

Introduction: Elective “prophylactic” tracheostomy has routinely been performed intraoperatively at the time of resection and reconstruction of defects of the head and neck for airway protection in anticipation of potential airway complications. We hypothesized that selected patients do not require “prophylactic” or intraoperative tracheostomy placement at the time of resection and free flap reconstruction.

Methods: Retrospective review over a 3-year period (2015-2018) of free flap reconstruction cases for defects resulting from the resection of head and neck pathology at Rush University Medical Center. Incidence and timing of tracheostomy placement, sites of resection and reconstruction, postoperative complications, length of stay (LOS), demographics, and procedure details were assessed.

Results: 88 patients (59 male, 29 female, average age 63.06 years) undergoing free flap reconstruction for defects resulting from the resection of head and neck pathology were included. 59 patients did not receive “prophylactic” tracheostomy and 29 received “prophylactic” tracheostomy at the time of surgery. Of the 29 “prophylactic” tracheostomies, 16 underwent decannulation prior to discharge. Compared to those patients who did not receive “prophylactic” tracheostomies, patients who received “prophylactic” tracheostomies had longer average ICU LOS (6.41 ± 1.54 days vs. 3.34 ± 0.14 days, p<0.006) and longer average total hospital LOS (15.10 ± 1.79 days vs. 10.68 ± 0.95 days, p<0.018). Those patients who received “prophylactic” tracheostomies had a higher incidence of airway-related postoperative complications compared to those patients who did not receive “prophylactic” tracheostomies (27.6% vs. 6.8%, respectively, p<0.011). There was no statistically significant difference in incidence of general postoperative complications between those who received “prophylactic” tracheostomies and those who did not receive “prophylactic” tracheostomies (48.3% vs. 44.1%, respectively, p<0.442). Among those patients who did not receive “prophylactic” tracheostomies, only 2 patients went on to require tracheostomies prior to discharge.

Conclusions: Patients who received “prophylactic” tracheostomies had increased ICU LOS, hospital LOS, and rate of airway-related postoperative complications, suggesting that select patients do not require “prophylactic” tracheostomy placement at the time of resection and free flap reconstruction.

Citation Format: Hannah N. Kuhar, Ashley Heilingoetter, Samer Al-Khudari, Peter C. Revenaugh, Pete S. Batra, Kerstin Stenson. Avoidance of “prophylactic” tracheostomy in free-flap reconstruction surgery of the head and neck: Implications for postoperative outcomes and patient quality of life [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B36.