Identification of patients for a delayed extubation strategy versus elective tracheostomy for postoperative airway management in major oral cancer surgery: A prospective observational study in seven hundred and twenty patients

• Main Authors: D'Cruz, A.K (Author), Dhar, H. (Author), Divatia, J.V (Author), Gupta, S. (Author), Myatra, S.N (Author), Rajanala, V. (Author), Sharma, S. (Author)
• Format: Article
• Language: English
• Published: Elsevier Ltd 2021
• Subjects: adult; Airway extubation; Airway Extubation; Airway management; Airway Management; analgesic agent; artery thrombosis; Article; bronchospasm; cancer center; cancer staging; cancer surgery; clinical practice; cohort analysis; Complications of airway management; Delayed extubation; elective surgery; Elective tracheostomy; endotracheal intubation; extubation; fasciocutaneous flap; female; fentanyl; fistula; flap congestion; flap dehiscence; fluid intake; general anesthesia; graft necrosis; heart muscle ischemia; human; Humans; hyperglycemia; hyponatremia; isoflurane; length of stay; lidocaine; major clinical study; male; mouth cancer; Mouth neoplasms; Mouth Neoplasms; mouth tumor; neck bleeding; neck dissection; neck hematoma; neostigmine; neuromuscular blocking agent; observational study; oxygen therapy; patient assessment; patient safety; peroperative care; Post-operative airway in oral cancer; postoperative care; postoperative complication; postoperative infection; preoperative radiotherapy; procedures; propofol; Prospective Studies; prospective study; reconstructive surgery; respiration control; risk factor; seroma; sevoflurane; speech; tertiary care center; tracheostomy; Tracheostomy
• Online Access: View Fulltext in Publisher

 Objectives: Tracheostomy (TT) and delayed extubation (DE) are two approaches to postoperative airway management in patients after major oral cancer surgery. We planned a study to determine the safety of overnight intubation followed by extubation the next morning (DE) compared to elective TT and to identify factors that were associated with a safe DE (maintenance of a patent airway). Material and methods: We conducted a prospective observational study in a tertiary referral cancer care center. We included adult patients undergoing elective major oral cancer surgery under general anesthesia with tracheal intubation. The decision regarding postoperative airway management using either TT or DE was made according to the usual practice at our center. Results: We screened a total of 4477 patients, 720 patients were included. DE was performed in 417 patients (58.4%) and TT in 303 patients (42.4%). On multivariable analysis, T1-T2 tumor stage, absence of extensive resection, primary closure or reconstruction using fasciocutaneous flap, absence of preoperative radiation, no neck dissection or unilateral neck dissection and shorter duration of anesthesia were independent predictors for a safe DE. Overall complications (4.3% versus 22.5%, p = 0.00) and airway complications (1.7% versus 8.7%, p = 0.00) were lower in the DE compared to the TT group respectively. DE was associated with a shorter hospital stay (7.2 ± 3.7 versus 11.5 ± 7.2 days, p = 0.00), time to oral intake and speech compared to TT. Conclusions: A DE strategy after major oral cancer surgery is a safe alternative to TT in a select group of patients. © 2021