Who is performing percutaneous tracheotomies? Practice patterns of surgeons in the USA

Abstract

Tracheotomy is one of the most common surgical procedures performed in the ICU setting. Traditionally tracheotomy has been performed by otolaryngologists as well as general surgeons. While percutaneous tracheotomy (PT) has been available for some time, it has only recently gained widespread acceptance with the advent of convenient and safe kits. Over the past decade, there has been increased utilization of this technique. However, there is a relative reluctance of certain surgical specialties to perform and train residents in PT; a previous study identified that only 29% of otolaryngology head and neck surgery (OTO-HNS) departments in the USA perform PT. In this study we aim to investigate the trends of PT usage in general surgery training programs and compare them to those previously described in otolaryngology programs. The study design is multi-institution physician survey and the study method was a survey of 250 general surgery program directors. This survey was identical to a published survey of OTO-HNS and a head-to-head comparison of results was performed. The response rate was 53% (133 programs). 89% of general surgery programs performed open tracheotomy on a regular basis. 75% performed percutaneous tracheotomy on a regular basis. 79% use the Ciaglia Blue Rhino method. Simultaneous video bronchoscopy was used by 67%. 83% of general surgery residency programs train their residents in PT. 61% felt that PT was either safer than or equal to open tracheotomy. PT is performed in a majority of general surgery residency programs and taught to their trainees. This is in contrast to otolaryngology residency programs, which have been shown to prefer open tracheotomies in both practice and teaching. This trend may severely impact the skills of the next generation of otolaryngologists.

The Decline of Tracheotomy among Otolaryngologists

“…Traditionally, tracheotomy has been performed by otolaryngologists as well as general surgeons. 1 The mandated restriction of resident duty hours has raised many concerns with regard to the training of professional, responsible surgeons for the future. 2 A major component of surgical training is performing enough cases to become competent.…”

“…Tracheotomy is one of the most common surgical procedures performed. Traditionally, tracheotomy has been performed by otolaryngologists as well as general surgeons 1 . The mandated restriction of resident duty hours has raised many concerns with regard to the training of professional, responsible surgeons for the future 2 .…”

Synthetic Simulator for Surgical Training in Tracheostomy and Open Airway Surgery

“…Tracheostomy involves creating a surgical opening through the neck into the trachea, most commonly performed to bypass an upper airway obstruction or for prolonged mechanical ventilation. Tracheostomy is an essential surgical skill for otolaryngologists‐head and neck surgeons, anesthesiologists, general surgeons, trauma surgeons, emergency and critical care physicians, emergency medical support workers, and military personnel 1 . LTR is a surgery for expanding the airway in patients with subglottic or tracheal stenosis, where the stenosed airway segment is divided and expanded with an autologous cartilage graft.…”

Tracheostomy Applications in Critically-Ill COVID-19 Patients

“…8,9 Bu nedenle, günümüzde trakeostomi, oransal olarak baş-boyun kanseri hastalarından sonra en çok yoğun bakımlarda yatan hastalarda uygulanmakta; yoğun bakımlardaki giderek artan hasta sayısı, yaşlanan nüfus ve başboyun kanser cerrahisinde giderek organ koruyucu cerrahilerin ön plana çıkmasıyla da pratikte trakeostominin en çok açıldığı hasta grubunu yoğun bakım hastaları oluşturmaktadır. [8][9][10][11][12] Kaynaklar trakeostominin giderek daha fazla belirli tek kullanımlık aletlerden oluşan patentli setlerden faydalanılarak kulak burun boğaz (KBB) dışındaki cerrahi ve özellikle de dâhili branş uzmanları tarafından açıldığını göstermekle birlikte, hâlen azımsanmayacak bir oranda KBB ekibi tarafından cerrahi diseksiyon yoluyla açılmaktadır. 13 Bu derleme yazısında, COVID-19 olan yoğun bakım hastalarında trakeostomi uygulamalarının zamanlaması, yöntemi ve işlem sırasında bulaşı önlemek amacıyla yapılması gerekenler ele alınmıştır.…”