Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
Department of Trauma Surgery, Catholic University of Korea College of Medicine, Seoul, Republic of Korea.
Am Surg. 2023 Oct;89(10):4153-4159. doi: 10.1177/00031348231180918. Epub 2023 Jun 2.
Evidence for the appropriate type of tracheostomy in patients with liver cirrhosis is lacking. A retrospective analysis of the National Inpatient Sample (NIS) was performed.
Adult patients with liver cirrhosis undergoing tracheostomy while on mechanical ventilation for respiratory failure were abstracted from the NIS database between 2016 and 2018 and analyzed. Patients were divided according to the type of tracheostomy performed into open tracheostomy (OT) and percutaneous tracheostomy (PT) and analyzed for tracheostomy complications and clinical outcomes. Subgroup analyses were performed for patients with compensated cirrhosis (CC) and decompensated cirrhosis (DC).
A total of 44745 cases were analyzed. The OT group had a higher rate of overall tracheostomy-related complications (TC) (5.1% vs 3.5%; < .001), hemorrhage from the tracheostomy site (HC) (2.7% vs 1.8%; = .008) and other complications (OC) (2.7% vs 1.8%, = .003). Multivariate analyses showed that OT was a risk factor for TC (Adjusted odds ratio (AOR) 1.50, < .001), HC (AOR 1.46, = .009), and OC (AOR 1.55, = .003). Similarly, in subgroup analyses, OT cases, compared to PT, were associated with increased TC (5.0% vs 3.4%, < .001), HC (2.7% vs 1.7%, = .002) and OC (2.6% vs 1.8%, = .020) in DC patients.
OT is associated with a significantly higher rate of complications. OT was also associated with more complications in DC patients, suggesting that a percutaneous approach may be the best option in cirrhotic patients when feasible.
缺乏肝硬化患者适当气管切开类型的证据。对国家住院患者样本（NIS）进行了回顾性分析。
从 NIS 数据库中提取 2016 年至 2018 年期间因呼吸衰竭行机械通气的肝硬化成年患者进行气管切开术，并进行分析。根据所行气管切开术的类型将患者分为开放式气管切开术（OT）和经皮气管切开术（PT），并分析气管切开术并发症和临床结局。对代偿性肝硬化（CC）和失代偿性肝硬化（DC）患者进行亚组分析。
共分析了 44745 例患者。OT 组总体气管切开术相关并发症（TC）发生率较高（5.1%比 3.5%；<.001），气管切开部位出血（HC）发生率较高（2.7%比 1.8%； =.008）和其他并发症（OC）发生率较高（2.7%比 1.8%； =.003）。多变量分析显示，OT 是 TC（调整比值比（AOR）1.50，<.001）、HC（AOR 1.46， =.009）和 OC（AOR 1.55， =.003）的危险因素。同样，在亚组分析中，与 PT 相比，OT 与 TC（5.0%比 3.4%，<.001）、HC（2.7%比 1.7%， =.002）和 OC（2.6%比 1.8%， =.020）发生率增加相关。
OT 与并发症发生率显著增加相关。OT 与 DC 患者的更多并发症相关，这表明在可行的情况下，经皮方法可能是肝硬化患者的最佳选择。
