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Safety of early tracheostomy in trauma patients after anterior cervical fusion

Lozano, Claudia P., MD; Chen, Kevin A., MD; Marks, Joshua A., MD; Jenoff, Jay S., MD; Cohen, Murray J., MD; Weinstein, Michael S., MD

Journal of Trauma and Acute Care Surgery: October 2018 - Volume 85 - Issue 4 - p 741–746
doi: 10.1097/TA.0000000000002045
ORIGINAL ARTICLES
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BACKGROUND Cervical spine injuries (CSIs) can have major effects on the respiratory system and carry a high incidence of pulmonary complications. Respiratory failure can be due to spinal cord injuries, concomitant facial fractures or chest injury, airway obstruction, or cognitive impairments. Early tracheostomy (ET) is often indicated in patients with CSI. However, in patients with anterior cervical fusion (ACF), concerns about cross-contamination often delay tracheostomy placement. This study aimed to demonstrate the safety of ET within 4 days of ACF.

METHODS Retrospective chart review was performed for all trauma patients admitted to our institution between 2001 and 2015 with diagnosis of CSI who required both ACF and tracheostomy, with or without posterior cervical fusion, during the same hospitalization. Thirty-nine study patients with ET (within 4 days of ACF) were compared with 59 control patients with late tracheostomy (5–21 days after ACF). Univariate and logistic regression analyses were performed to compare risk of wound infection, length of intensive care unit and hospital stay, and mortality between both groups during initial hospitalization.

RESULTS There was no difference in age, sex, preexisting pulmonary or cardiac conditions, Glasgow Coma Scale score, Injury Severity Score, Chest Abbreviated Injury Scale score, American Spinal Injury Association score, cervical spinal cord injury levels, and tracheostomy technique between both groups. There was no statistically significant difference in surgical site infection between both groups. There were no cases of cervical fusion wound infection in the ET group (0%), but there were five cases (8.47%) in the late tracheostomy group (p = 0.15). Four involved the posterior cervical fusion wound, and one involved the ACF wound. There was no statistically significant difference in intensive care unit stay (p = 0.09), hospital stay (p = 0.09), or mortality (p = 0.06) between groups.

CONCLUSION Early tracheostomy within 4 days of ACF is safe without increased risk of infection compared with late tracheostomy.

LEVEL OF EVIDENCE Evidence, level III.

From the General Surgery Residency (C.P.L.G.), Beth Israel Deaconess Medical Center, Boston, Massachusetts; and Sidney Kimmel Medical College (C.P.L.G., K.A.C., J.A.M., J.S.J., M.J.C., M.S.W.), Thomas Jefferson University, Philadelphia, Pennsylvania; and Acute Care Surgery Division, Department of Surgery (J.A.M., J.S.J., M.S.W., M.J.C.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.

Submitted: March 26, 2017, Revised: June 7, 2018, Accepted: June 12, 2018, Published online: July 27, 2018.

Address for reprints: Claudia P. Lozano, MD, Sidney Kimmel Medical College at Thomas Jefferson University, 1100 Walnut St, Suite 702, Philadelphia, PA 19107; email: Claudia.Lozano.Bidmc@gmail.com.

© 2018 Lippincott Williams & Wilkins, Inc.