(0310) Do Bjork Flaps Prevent Major Complications?

Introduction: First described in 1960, Bjork flaps are intended to reduce the sheer forces that are generated against the tracheal mucosa, but have also been hypothesized to make tracheostomies safer. This retrospective review investigates whether the presence of the Bjork flap prevents major postoperative complications.

Methods: An IRB-approved retrospective review from a single academic institution was designed. Open adult tracheostomies performed from all services from 2019 to 2022 were collected and chart reviewed for up to 7 days post-operatively. Outcomes between two groups were analyzed: those with Bjork flaps and those with horizontal tracheotomy incisions. Major complications were defined as any event that risked the loss of airway, or ventilatory support, or that risked grave injury. Statistical analysis was performed to analyze for significance.

Results: A total of 204 tracheostomies were included in the analysis after screening. 66.7% of tracheostomies were done with Bjork flaps. No significant difference in major complication rate in early period between tracheostomies with or without Bjork flap creation (p = 0.49). No significant influence on major complication rate due to BMI or age or gender. Patients with prolonged intubation were more likely to have a major complication (p = 0.01). There was no significant difference in major complication rate in the early postoperative period between the surgical services (p = 0.45).

Conclusions: Bjork flaps did not appear to be associated with any decreased risk of major complications in the early postoperative period. Patients who received tracheostomies due to prolonged intubation or acute respiratory failure were more likely to experience a major complication. Limitations include those of a retrospective review and a large potential for reporting bias given the non-standardization of postoperative reporting and outcome measurement. Further investigations would involve investigating the impact of early postoperative suturing of the tracheostomy flange to the skin, and whether or not the type of tracheostomy tube has an impact on postoperative complications.