Safety of Early Tracheostomy in Trauma Patients After Anterior Cervical Fusion

Background Cervical spine injuries (CSI) can have major effects on the respiratory system and carry a high incidence of pulmonary complications. Respiratory failure can be due to spinal cord injuries, concomitant facial fractures or chest injury, airway obstruction, or cognitive impairments. Early tracheostomy (ET) is often indicated in patients with CSI. However, in patients with anterior cervical fusion (ACF), concerns about cross-contamination often delay tracheostomy placement. This study aims to demonstrate the safety of ET within four days of ACF Methods Retrospective chart review was performed for all trauma patients admitted to our institution between 2001-2015 with diagnosis of CSI who required both ACF and tracheostomy, +/- posterior cervical fusion (PCF), during the same hospitalization. 39 study patients with ET (within four days of ACF) were compared to 59 control patients with late tracheostomy (LT) (5-21 days after ACF). Univariate and logistic regression analyses were performed to compare risk of wound infection, length of ICU and hospital stay, and mortality between both groups during initial hospitalization. Results There was no difference in age, sex, pre-existing pulmonary or cardiac conditions, Glasgow Comas Scale (GCS), Injury Severity Score, Chest Abbreviated Injury Scale, American Spinal Injury Association (ASIA) score, CSCI levels, and tracheostomy technique between both groups. There was no statistically significant difference in surgical site infection between both groups. There were no cases of cervical fusion wound infection in the ET group (0%), but five cases (8.47%) in the LT group (p=0.15). 4 involved the PCF wound and 1, the ACF wound. There was no statistically significant difference in ICU stay (p=0.09), hospital stay (p=0.09), or mortality (p=0.06) between groups. Conclusion Early tracheostomy within four days of ACF is safe without increased risk of infection compared to late tracheostomy. Level of evidence This study represents level III evidence. Corresponding: Claudia Patricia Lozano Guzman, MD, General Surgery Residency: Beth Israel Deaconess Medical Center. Surgical Critical Care Fellowship: Sidney Kimmel Medical College at Thomas Jefferson University. Email: Claudia.Lozano.Bidmc@gmail.com, Address: 1100 Walnut Street. Suite 702. Philadelphia, PA. 19107. Phone: 617 301 2624, Fax: 215 923 7957 Conflict of Interest I have no conflict of interest, I have no financial support of any kind including pharmaceutical and industrial. I received no funding or support from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; and the Howard Hughes Medical Institute (HHMI). Presentations This study was presented at the 75th Annual Meeting of the American Association for the Surgery of Trauma and Clinical Congress of Acute Care Surgery, September 14-17, 2016, Waikoloa, Hawaii. © 2018 Lippincott Williams & Wilkins, Inc.

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