Schuderer Johannes G, Reider Leonie, Wunschel Michael, Spanier Gerrit, Spoerl Steffen, Gottsauner Maximilian Josef, Maurer Michael, Meier Johannes K, Kummer Peter, Reichert Torsten E, Ettl Tobias
Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany.
Section Phoniatrics and Pediatric Audiology, Department of Otolaryngology, University Hospital Regensburg, 93053 Regensburg, Germany.
J Clin Med. 2023 Jan 22;12(3):883. doi: 10.3390/jcm12030883.
Elective tracheotomy (ET) secures the airway and prevents adverse airway-related events as unplanned secondary tracheotomy (UT), prolonged ventilation (PPV) or nosocomial infection. The primary objective of this study was to identify factors predisposing for airway complications after reconstructive lower ja surgery. We reviewed records of patients undergoing mandibulectomy and microvascular bone reconstruction (N = 123). Epidemiological factors, modus of tracheotomy regarding ET and UT, postoperative ventilation time and occurrence of hospital-acquired pneumonia HAP were recorded. Predictors for PPV and HAP, ET and UT were identified. A total of 82 (66.7%) patients underwent tracheotomy of which 12 (14.6%) were performed as UT. A total of 52 (42.3%) patients presented PPV, while 19 (15.4%) developed HAP. Increased operation time (OR 1.004, = 0.005) and a difficult airway (OR 2.869, = 0.02) were predictors, while ET reduced incidence of PPV (OR 0.054, = 0.006). A difficult airway (OR 4.711, = 0.03) and postoperative delirium (OR 6.761, = 0.01) increased UT performance. HAP increased with anesthesia induction time (OR 1.268, = 0.001) and length in ICU (OR 1.039, = 0.009) while decreasing in ET group (HR 0.32, = 0.02). OR for ET increased with mounting CCI (OR 1.462, = 0.002) and preoperative radiotherapy (OR 2.8, = 0.018). ET should be strongly considered in patients with increased CCI, preoperative radiotherapy and prolonged operation time. ET shortened postoperative ventilation time and reduced HAP.
选择性气管切开术（ET）可确保气道安全，并预防与气道相关的不良事件，如非计划性二次气管切开术（UT）、延长通气时间（PPV）或医院感染。本研究的主要目的是确定下颌骨重建术后气道并发症的易感因素。我们回顾了接受下颌骨切除术和微血管骨重建的患者记录（N = 123）。记录了流行病学因素、ET和UT的气管切开方式、术后通气时间以及医院获得性肺炎（HAP）的发生情况。确定了PPV和HAP、ET和UT的预测因素。共有82例（66.7%）患者接受了气管切开术，其中12例（14.6%）为UT。共有52例（42.3%）患者出现PPV，19例（15.4%）发生HAP。手术时间延长（OR 1.004，P = 0.005）和气道困难（OR 2.869，P = 0.02）是预测因素，而ET降低了PPV的发生率（OR 0.054，P = 0.006）。气道困难（OR 4.711，P = 0.03）和术后谵妄（OR 6.761，P = 0.01）增加了UT的实施率。HAP随着麻醉诱导时间（OR 1.268，P = 0.001）和在重症监护病房的住院时间（OR 1.039，P = 0.009）而增加，而在ET组中则降低（HR 0.32，P = 0.02）。ET的OR随着CCI的增加（OR 1.462，P = 0.002）和术前放疗（OR 2.8，P = 0.018）而增加。对于CCI增加、术前放疗和手术时间延长的患者，应强烈考虑行ET。ET缩短了术后通气时间并降低了HAP。
