Early percutaneous dilational tracheostomy does not lead to an increased risk of surgical site infection following anterior spinal surgery.

Background: Most patients suffering cervical spinal cord injuries require tracheostomy. The optimal timing is still a matter of debate. Previous studies showed that patients receiving early tracheostomy had fewer ventilator days, decreased rates of pneumonia, and were mobilized earlier. Due to the proximity of the anterior approach to the tracheostoma, there is concern about an increased risk of surgical site infection related to tracheostomy. Methods: Retrospective analysis at a Level 1 trauma center of patient records from 2008-2014, identifying all patients with spinal cord injury who received anterior cervical spinal surgery and had early percutaneous dilational tracheostomy. Follow-up for surgical site infection was performed throughout hospital stay (mean 110 days, median 96 days with lower quartile 89 days and upper quartile 119 days) and at 6 weeks and 3 months (clinical examination and computed tomography scans). Results: Fifty-one patients underwent anterior spinal surgery with percutaneous dilational tracheostomy performed within a median of 5 days (range 1 to 18 days). Seventy-eight percent (n=40) of patients had anterior spinal surgery, whereas 22% (n=11) had a combined anterior-posterior repair. All percutaneous dilational tracheostomies were performed using the Ciaglia single step dilation technique. Despite a surgical site infection of one patient's cannulation site, no surgical site infection of the anterior approach was observed. Conclusion: Performing a percutaneous dilational tracheostomy in a timely fashion after anterior spinal surgery does not increase the risk of surgical site infection. Background: Most patients suffering cervical spinal cord injuries require tracheostomy. The optimal timing is still a matter of debate. Previous studies showed that patients receiving early tracheostomy had fewer ventilator days, decreased rates of pneumonia, and were mobilized earlier. Due to the proximity of the anterior approach to the tracheostoma, there is concern about an increased risk of surgical site infection related to tracheostomy. Methods: Retrospective analysis at a Level 1 trauma center of patient records from 2008-2014, identifying all patients with spinal cord injury who received anterior cervical spinal surgery and had early percutaneous dilational tracheostomy. Follow-up for surgical site infection was performed throughout hospital stay (mean 110 days, median 96 days with lower quartile 89 days and upper quartile 119 days) and at 6 weeks and 3 months (clinical examination and computed tomography scans). Results: Fifty-one patients underwent anterior spinal surgery with percutaneous dilational tracheostomy performed within a median of 5 days (range 1 to 18 days). Seventy-eight percent (n=40) of patients had anterior spinal surgery, whereas 22% (n=11) had a combined anterior-posterior repair. All percutaneous dilational tracheostomies were performed using the Ciaglia single step dilation technique. Despite a surgical site infection of one patient's cannulation site, no surgical site infection of the anterior approach was observed. Conclusion: Performing a percutaneous dilational tracheostomy in a timely fashion after anterior spinal surgery does not increase the risk of surgical site infection. Background: Most patients suffering cervical spinal cord injuries require tracheostomy. The optimal timing is still a matter of debate. Previous studies showed that patients receiving early tracheostomy had fewer ventilator days, decreased rates of pneumonia, and were mobilized earlier. Due to the proximity of the anterior approach to the tracheostoma, there is concern about an increased risk of surgical site infection related to tracheostomy. Methods: Retrospective analysis at a Level 1 trauma center of patient records from 2008-2014, identifying all patients with spinal cord injury who received anterior cervical spinal surgery and had early percutaneous dilational tracheostomy. Follow-up for surgical site infection was performed throughout hospital stay (mean 110 days, median 96 days with lower quartile 89 days and upper quartile 119 days) and at 6 weeks and 3 months (clinical examination and computed tomography scans). Results: Fifty-one patients underwent anterior spinal surgery with percutaneous dilational tracheostomy performed within a median of 5 days (range 1 to 18 days). Seventy-eight percent (n=40) of patients had anterior spinal surgery, whereas 22% (n=11) had a combined anterior-posterior repair. All percutaneous dilational tracheostomies were performed using the Ciaglia single step dilation technique. Despite a surgical site infection of one patient's cannulation site, no surgical site infection of the anterior approach was observed. Conclusion: Performing a percutaneous dilational tracheostomy in a timely fashion after anterior spinal surgery does not increase the risk of surgical site infection. Background: Most patients suffering cervical spinal cord injuries require tracheostomy. The optimal timing is still a matter of debate. Previous studies showed that patients receiving early tracheostomy had fewer ventilator days, decreased rates of pneumonia, and were mobilized earlier. Due to the proximity of the anterior approach to the tracheostoma, there is concern about an increased risk of surgical site infection related to tracheostomy. Methods: Retrospective analysis at a Level 1 trauma center of patient records from 2008-2014, identifying all patients with spinal cord injury who received anterior cervical spinal surgery and had early percutaneous dilational tracheostomy. Follow-up for surgical site infection was performed throughout hospital stay (mean 110 days, median 96 days with lower quartile 89 days and upper quartile 119 days) and at 6 weeks and 3 months (clinical examination and computed tomography scans). Results: Fifty-one patients underwent anterior spinal surgery with percutaneous dilational tracheostomy performed within a median of 5 days (range 1 to 18 days). Seventy-eight percent (n=40) of patients had anterior spinal surgery, whereas 22% (n=11) had a combined anterior-posterior repair. All percutaneous dilational tracheostomies were performed using the Ciaglia single step dilation technique. Despite a surgical site infection of one patient's cannulation site, no surgical site infection of the anterior approach was observed. Conclusion: Performing a percutaneous dilational tracheostomy in a timely fashion after anterior spinal surgery does not increase the risk of surgical site infection. Background: Most patients suffering cervical spinal cord injuries require tracheostomy. The optimal timing is still a matter of debate. Previous studies showed that patients receiving early tracheostomy had fewer ventilator days, decreased rates of pneumonia, and were mobilized earlier. Due to the proximity of the anterior approach to the tracheostoma, there is concern about an increased risk of surgical site infection related to tracheostomy. Methods: Retrospective analysis at a Level 1 trauma center of patient records from 2008-2014, identifying all patients with spinal cord injury who received anterior cervical spinal surgery and had early percutaneous dilational tracheostomy. Follow-up for surgical site infection was performed throughout hospital stay (mean 110 days, median 96 days with lower quartile 89 days and upper quartile 119 days) and at 6 weeks and 3 months (clinical examination and computed tomography scans). Results: Fifty-one patients underwent anterior spinal surgery with percutaneous dilational tracheostomy performed within a median of 5 days (range 1 to 18 days). Seventy-eight percent (n=40) of patients had anterior spinal surgery, whereas 22% (n=11) had a combined anterior-posterior repair. All percutaneous dilational tracheostomies were performed using the Ciaglia single step dilation technique. Despite a surgical site infection of one patient's cannulation site, no surgical site infection of the anterior approach was observed. Conclusion: Performing a percutaneous dilational tracheostomy in a timely fashion after anterior spinal surgery does not increase the risk of surgical site infection. Level of evidence: V, Study design: Retrospective case control study (C) 2016 Lippincott Williams & Wilkins, Inc.

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