Key Seraphina, Chia Clemente, Del Rio Marcus, Phyland Debra, Giddings Charles
Department of Otolaryngology Head and Neck Surgery, Monash Health, VIC 3168, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia.
Department of Otolaryngology Head and Neck Surgery, Monash Health, VIC 3168, Australia.
Auris Nasus Larynx. 2024 Dec;51(6):990-995. doi: 10.1016/j.anl.2024.10.007. Epub 2024 Oct 18.
Tracheostomy in the setting of head and neck cancer may be performed either electively for prophylactic airway protection in an ablative procedure, or as an emergency due to impending airway obstruction in the setting of an obstructing upper aerodigestive tract malignancy. Tracheostomy care has biopsychosocial implications, which may require a higher level of care from carers, post-acute care, or placement into care facilities. Existing database studies have largely excluded patients with a history of head and neck cancer. This study aims to examine and compare discharge destinations for head and neck cancer patients requiring either elective or emergency surgical tracheostomies.
Retrospective cohort study (January 2010-December 2019) of adult head and neck cancer patients undergoing surgical tracheostomy in a tertiary Australian hospital network. Primary outcome was discharge destination. Secondary outcomes were mortality, morbidity, and decannulation timing.
Of 188 patients (47 emergency, 141 elective), 83.0 % returned to their pre-morbid accommodation, either directly home (54.6 %), or with additional community-based services (27.7 %). There was a significant difference in post-discharge destination (p = 0.012). Emergency patients were less likely to return home compared to elective patients (OR 0.76, 95 % CI 0.32-1.79), and more likely to require additional supports on discharge(67.6 %) compared to elective(41.9 %) patients. However, these outcomes did not demonstrate statistical significance. Emergency tracheostomy patients were at higher risk of permanent tracheostomy, unplanned readmission within 30 days, and longer time to successful decannulation.
Emergency tracheostomy patients are likely to return to their pre-morbid place of residence but may require additional support.
头颈部癌症患者行气管切开术，既可以在消融手术中作为预防性气道保护措施选择性地进行，也可以在梗阻性上消化道恶性肿瘤导致即将出现气道阻塞时作为紧急措施进行。气管切开护理具有生物心理社会学意义，这可能需要护理人员提供更高水平的护理、急性后期护理或安置到护理机构。现有的数据库研究在很大程度上排除了有头颈部癌症病史的患者。本研究旨在检查和比较需要选择性或紧急手术气管切开术的头颈部癌症患者的出院去向。
对澳大利亚一家三级医院网络中接受手术气管切开术的成年头颈部癌症患者进行回顾性队列研究（2010年1月至2019年12月）。主要结局是出院去向。次要结局是死亡率、发病率和拔管时间。
在188例患者中（47例紧急手术，141例选择性手术），83.0%的患者回到了病前住所，要么直接回家（54.6%），要么接受额外的社区服务（27.7%）。出院后去向存在显著差异（p = 0.012）。与选择性手术患者相比，紧急手术患者回家的可能性较小（OR 0.76，95%CI 0.32 - 1.79），且出院时比选择性手术患者（41.9%）更有可能需要额外支持（67.6%）。然而，这些结局未显示出统计学意义。紧急气管切开术患者永久性气管切开、30天内非计划再入院以及成功拔管时间更长的风险更高。
紧急气管切开术患者可能会回到病前居住地，但可能需要额外支持。
