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Head and Neck Surgery

(0750) Tracheostomy in Flap-Based Surgeries: A Systematic Review and Meta-analysis on Factors, Complications, and Temporal Trends

Monday, September 30, 2024
12:00 PM – 1:00 PM EDT
Disclosure(s):
Dana Al-Majid, MD: No relevant relationships to disclose.
Raisa Chowdhury, MSc: No relevant relationships to disclose.
Sena Turkdogan, MD: No relevant relationships to disclose.


Introduction: Conduct a thorough systematic review and meta-analysis to examine the nuanced aspects of tracheostomy in head and neck flap-based surgeries, unveiling key insights into predictive factors, complications, and temporal trends.

Methods: A systematic search, conducted on July 17, 2023, covered databases (PubMed, Cochrane, Embase, Web of Science, ClinicalTrials.gov) using keywords such as "tracheostomy," "surgical procedures," "airway management," "head and neck neoplasms," and "free flap surgery". Inclusion criteria encompassed studies on adults undergoing head and neck flap-based surgeries with tracheostomy outcomes. Two reviewers independently screened and extracted data. Meta-analysis was performed using comprehensive Meta-Analysis Software. Outcomes included tracheostomy rates, complications, and predictive factors.

Results: 20 studies were included (16 retrospective reviews, 2 prospective cohort studies, 1 case series, and 1 clinical trial) spanning 1996 to 2022. Tracheostomy rates significantly rose after 2017 (51.4% [CI=39.8-62.9%]). Complications occurred in 15.5% [CI=9.7-23.8%] of tracheostomized patients, with notable concerns about site infections. Limited data for demographic and length of hospital stay comparisons favored non-tracheostomy groups. Various predictive factors for tracheostomy necessity were identified, emphasizing cancer location (mandible, oropharynx, and tongue), tumor stage (higher likelihood in T3 and T4), and type of free flap used (increased morbidity with thick/bulky free flaps, particularly radial forearm flaps).

Conclusions: Tracheostomy remains pivotal in head and neck flap-based surgeries, requiring careful consideration of predictive factors. Evolving trends underscore the need for continuous evaluation and refinement of selection criteria. This comprehensive review guides clinicians to optimize tracheostomy decisions for enhanced patient outcomes.