Elective tracheostomy scoring system for severe oral disease patients

Abstract

ObjectivesThe purpose of this research was to create a scoring system that provides comprehensive assessment of patients with oromaxillofacial cancer or odontogenic infection, and to statistically reevaluate the results in order to provide specific criteria for elective tracheostomy.Materials and MethodsAll patients that had oral cancer surgery (group A) or odontogenic infection surgery (group B) during a period of 10 years (2003 to 2013) were subgrouped according to whether or not the patient received a tracheostomy. After a random sampling (group A: total of 56, group B: total of 60), evaulation procedures were observed based on the group classifications. For group A, four factors were evaluated: TNM stage, reconstruction methods, presence of pathologic findings on chest posterior-anterior (PA), and the number of systemic diseases. Scores were given to each item based on the scoring system suggested in this research and the scores were added together. Similarly, the sum score of group B was counted using 5 categories, including infection site, C-reactive protein level on first visit, age, presence of pathologic findings on chest PA, and number of systemic diseases.ResultsThe scoring system rendered from this research shows that there is a high correlation between the scores and TNM stage in oral cancer patients, or infection sites in odontogenic infection patients. However, no correlation between pathologic findings on chest PA could be found in either group. The results also indicated that for both groups, the hospital day increased with the tracheostomy score. The tracheostomy score cutoff value was 5 in oral cancer patients and 6 in odontogenic infection patients which was used for elective tracheostomy indication.ConclusionThe elective tracheostomy score system suggested by this research is a method that considers both the surgical and general conditions of the patient, and can be very useful for managing patients with severe oral disease.

Assessment of the degree of agreement between the judgment of tracheotomy score and the clinician: a retrospective analysis

“…As a result of metastasis, neck dissection only was performed in 13 patients; extubation was performed in all of these patients ( Table 1). Detailed results of scores, using the methods reported by Cameron [9] and Gupta [11], are shown in Fig. 1 and Table 2.…”

“…Therefore, research to establish criteria for performing tracheotomy is required. There have been several reports regarding evaluation methods to predict the necessity for selective tracheotomy in patients with oral cancer [9][10][11][12]. However, these methods may not be applicable for all patients due to disparities among institutions or differences in patient backgrounds.…”

“…Usually large tumors (T4), the mouth oor or posterior lesions on the tongue, and bilateral neck dissection were considered for elective tracheotomy. Various factors contributed to the need for tracheotomy in patients, ranging from the extent of surgical resection to 1) patient background; 2) resection procedure, inclusion/exclusion of neck dissection, and reconstruction procedure; 3) method of airway management; and 4) scoring based on previously reported indices [8][9][10][11]. The parameters of the indices were evaluated and scored based on the patients' medical and imaging records.…”

“…However, according to literature, tracheotomy is associated with reported complication rates of 8-45% [8]. Therefore, some studies have been conducted to predict appropriate airway management strategies [9][10][11][12].…”

Protocol based evaluation for feasibility of extubation compared to clinical scoring systems after major oral cancer surgery safely reduces the need for tracheostomy: a retrospective cohort study

“…To identify patients with indicative need for tracheostomy and those patients who can be safely treated without tracheostomy, multiple clinical scoring systems have been published previously [ 13 – 16 ]. However the published clinical scoring systems often lack of evaluating delayed extubation as possible option to avoid tracheostomy [ 17 ].…”