Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
J Surg Res. 2021 Apr;260:116-121. doi: 10.1016/j.jss.2020.11.066. Epub 2020 Dec 15.
Tracheostomy is commonly used for managing the airway of trauma patients. Complications are common and result in increased length of stays and treatment cost. The aim of this study is to evaluate whether the utilization of skin sutures or foam barrier dressings affect tracheostomy complication rates.
This is a single-center retrospective review of patients who underwent a tracheostomy by the trauma service between January 2014 and December 2017. Collected variables included demographics, patient history, treatment variables, complications, and outcomes. Univariate and multivariate analyses were constructed to identify significant predictors for the development of complications.
A total of 268 patients were included. The median age was 43.5 y, 221 (82.5%) patients were men, and the median BMI was 28 (IQR 24.6, 32.2). Most (87.3%) of the procedures were performed in the operating room and 82.5% were open. Skin sutures were used in 46.3% and 53.4% had a foam barrier dressing placed. Current smoking [OR 8.1 (95% CI 1.5, 43.6)] and BMI [OR 1.1 (95% CI 1.03, 1.2)] significantly increased the risk of developing pressure necrosis. Use of sutures or foam dressings was not associated with pressure necrosis, bleeding, or surgical site infection. There were no unexpected tracheostomy decannulations regardless of the use of skin sutures.
Suturing the tracheostomy or applying a foam barrier dressing was not associated with overall complications or decannulation rates. Based on our data, we suggest that skin sutures may be safely abandoned.
气管切开术常用于创伤患者的气道管理。并发症很常见，会导致住院时间延长和治疗费用增加。本研究旨在评估使用皮肤缝线或泡沫屏障敷料是否会影响气管切开术的并发症发生率。
这是一项对 2014 年 1 月至 2017 年 12 月期间由创伤科实施的气管切开术患者进行的单中心回顾性研究。收集的变量包括人口统计学、患者病史、治疗变量、并发症和结局。进行了单变量和多变量分析，以确定并发症发生的显著预测因素。
共纳入 268 例患者。患者的中位年龄为 43.5 岁，221 例（82.5%）为男性，中位 BMI 为 28（IQR 24.6，32.2）。大多数（87.3%）手术在手术室进行，82.5%为开放式。46.3%使用皮肤缝线，53.4%使用泡沫屏障敷料。目前吸烟[OR 8.1（95% CI 1.5，43.6）]和 BMI [OR 1.1（95% CI 1.03，1.2）]显著增加了发生压力性坏死的风险。使用缝线或泡沫敷料与压力性坏死、出血或手术部位感染无关。无论是否使用皮肤缝线，均未发生意外的气管切开管拔管。
气管切开处缝合或应用泡沫屏障敷料与总体并发症或拔管率无关。根据我们的数据，我们建议可以安全地放弃皮肤缝线。
