Risk Factors for Posttracheostomy Tracheal Stenosis

Abstract

Objective To determine the incidence of posttracheostomy tracheal stenosis and to investigate variables related to the patient, hospitalization, or operation that may affect stenosis rates. Study Design A combined retrospective cohort and case-control study. Setting Tertiary care academic medical center. Subjects and Methods A total of 1656 patients who underwent tracheostomy at a tertiary care medical center from January 2011 to November 2016 were reviewed for evidence of subsequent tracheal stenosis on airway endoscopy or computed tomography. Forty-three confirmed cases of posttracheostomy tracheal stenosis (PTTS) were compared with a subgroup of 319 controls. Factors including medical comorbidity, type and setting of tracheostomy, and hospitalization details were analyzed. Results Five-year incidence of PTTS was 2.6%. Obesity was the sole demographic factor associated with stenosis. Hospitalization-related variables associated with stenosis included tracheostomy after 10 days of orotracheal intubation and endotracheal tube cuff pressure ≥30 mm HO. The surgical variables associated with higher rates of stenosis included percutaneous technique and insertion of an initial tracheostomy tube size >6. Bjork flap creation was negatively associated with stenosis. In multivariable analysis, obesity and insertion of tracheostomy tube size >6 were identified as risk factors. Conclusion Greater than 10 days of orotracheal intubation prior to tracheostomy and endotracheal tube cuff pressure ≥30 mm HO were associated with greater rates of subsequent tracheal stenosis. The only patient-related factor associated with tracheal stenosis was obesity. Surgical variables associated with increased rates of subsequent stenosis included placement of a tracheostomy tube size >6, use of percutaneous technique, and failure to create a Bjork flap.

Comparison of the efficacy of surgical tracheostomy and percutaneous dilatational tracheostomy with flexible lightwand and ultrasonography in geriatric intensive care patients

“…18,[22][23][24] Rates have been reported to vary between 1.5% and 1.7% depending on various factors, such as obesity, the need for a wide diameter tracheostomy and long-term mechanical ventilation. 25 In a series of 88 percutaneous tracheostomy cases, Wagner et al reported the development of TS in eight (9.1%) patients. 24 The results of the current study were consistent with the literature in respect to TS.…”

“…TS is the narrowing of the tracheal lumen by fibrosis or granulation tissue . Rates have been reported to vary between 1.5% and 1.7% depending on various factors, such as obesity, the need for a wide diameter tracheostomy and long‐term mechanical ventilation . In a series of 88 percutaneous tracheostomy cases, Wagner et al .…”

Perioperative outcomes after tracheoplasty: A NSQIP analysis 2014–2016

“…Idiopathic subglottic stenosis, which can extend into the upper trachea, plays a role. However, data suggests that the risk associated with intubation is the most common cause of tracheal stenosis, and intubation risk may excessively affect women . Another consideration is that women in this sample may be more symptomatic or relatively healthier than men with tracheal stenosis and therefore were more likely to undergo tracheoplasty.…”

“…There is good evidence that the risk of tracheal stenosis after tracheostomy is increased among obese patients . The etiology may be multifactorial.…”

“…Yet, the airway size may be similar to a normal weight person. There is also data that suggests the risk of percutaneous tracheostomy, which is increasing in popularity, increases the risk of stenosis in the obese population …”