A Retrospective Study of Cricotracheostomy: Indications, Techniques, and Clinical Outcomes

Overview

Journal Otolaryngol Head Neck Surg

Publisher Wiley

Specialties General Surgery
Otorhinolaryngology

Date 2024 Nov 11

PMID 39523566

Authors

Kana Nanjo

Rumi Ueha

Maria A Dealino

Naoyuki Matsumoto

Taku Sato

Takao Goto

Kenji Kondo

Affiliations

Soon will be listed here.

Abstract

Objectives: Cricotracheostomy (CT) is a surgical procedure for airway access that can be performed using 2 techniques: excising the cricoid cartilage (CTrach), or by creating an inverted U-shaped flap from the first tracheal ring (CTrachT). The aims of this study are to clinically evaluate factors such as patient background, complications, and stoma closure status in patients who underwent CT, and to compare the clinical outcomes between CTrach and CTrachT.

Study Design: Retrospective, cross-sectional study.

Setting: Single-institution academic center.

Methods: Records of patients who underwent CT at the University of Tokyo Hospital between 2014 and March 2024 were reviewed, detailing their demographics and clinical characteristics. We investigated differences in clinical backgrounds, complication risks for each surgical procedure, and factors contributing to stoma closure and complications after CT.

Results: The median age for patients undergoing CT was 70 years, predominantly male (76%), and most were malnourished. Common indications included low-lying larynx and obesity. Stoma closure was achieved in 16% of patients. Early complications were surgical site infection (9%) and subcutaneous emphysema (2%), with granuloma formation in 20%. The CTrach group had a significantly higher median age (P = .03), but other factors showed no significant differences. CTrachT was more often performed by board-certified specialists (P = .04). Stoma closure rates and complications were not significantly influenced by any single factor.

Conclusion: CT presents a viable option with minimal postoperative complications for patients wherein conventional tracheotomy may be more challenging, such as in low-lying larynx, obesity, advanced age, and poor nutritional status.

References

Kasahara K, Nishiyama T, Shigetomi S, Ikari Y, Matsui Y, Ozawa H . Cricotracheostomy in a patient with severe kyphosis: A case report. Ear Nose Throat J. 2022; 103(11):NP633-NP636. DOI: 10.1177/01455613221077596. View

Roy C, Silver J, Turkdogan S, Siafa L, Correa J, Kost K . Complication Rate of Percutaneous Dilatational Tracheostomy in Critically Ill Adults With Obesity: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. 2023; 149(4):334-343. PMC: 9912163. DOI: 10.1001/jamaoto.2022.4824. View

Fattahi T, Chafin C, Bunnell A . Tracheostomy in the Morbidly Obese: Difficulties and Challenges. J Oral Maxillofac Surg. 2017; 75(7):1372-1375. DOI: 10.1016/j.joms.2016.12.030. View

Tamir S, Khalaily N, Einav S, Shemesh S, Gluck O, Marom T . 30-Day Morbidity and Mortality Rates in Elderly Subjects Following Surgical Tracheostomy. Respir Care. 2018; 63(8):1009-1015. DOI: 10.4187/respcare.06002. View

Park J, Chung W, Song S, Kim Y, Lim C, Ko Y . Identifying the ideal tracheostomy site based on patient characteristics during percutaneous dilatational tracheostomy without bronchoscopy. Korean J Anesthesiol. 2019; 72(3):233-237. PMC: 6547237. DOI: 10.4097/kja.d.18.00276. View

Kano M, Hasegawa H . Cricotracheostomy: new technique to open an airway in emergencies with partial resection of the cricoid cartilage. Br J Oral Maxillofac Surg. 2016; 55(1):84-85. DOI: 10.1016/j.bjoms.2016.05.004. View

Abi Zeid Daou C, Chahine E, Barazi R . Assessment of Tracheostomy Tube Placement and Late Change Practices in an Academic Tertiary Care Center. Int Arch Otorhinolaryngol. 2024; 28(3):e407-e414. PMC: 11226274. DOI: 10.1055/s-0043-1776723. View

Koyama M, Ueha R, Sato T, Goto T, Yamauchi A, Kaneoka A . Aspiration Prevention Surgery: Clinical Factors Associated With Improvements in Oral Status Intake and Suction Frequency. Otolaryngol Head Neck Surg. 2023; 168(5):1146-1155. DOI: 10.1002/ohn.183. View

Onodera T, Goseki N, KOSAKI G . [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi. 1984; 85(9):1001-5. View

10.

Barrera S, Sanford E, Ammerman S, Ferrell J, Simpson C, Dominguez L . Postoperative Complications in Obese Patients After Tracheostomy. OTO Open. 2020; 4(3):2473974X20953090. PMC: 7453467. DOI: 10.1177/2473974X20953090. View

11.

Tavin E, Singer L, Bassila M . Problems in postoperative management after anterior cricoid split. Arch Otolaryngol Head Neck Surg. 1994; 120(8):823-6. DOI: 10.1001/archotol.1994.01880320025006. View

12.

Tochigi K, Sakamoto H, Omura K, Kessoku H, Takeda T, Oguro R . Safety of cricotracheostomy with skin and tracheal membrane flaps for severe COVID-19 patients. Auris Nasus Larynx. 2024; 51(3):583-587. DOI: 10.1016/j.anl.2024.03.003. View

13.

Levy L, Smiley A, Latifi R . Mortality Risk Factors in Patients Admitted with the Primary Diagnosis of Tracheostomy Complications: An Analysis of 8026 Patients. Int J Environ Res Public Health. 2022; 19(15). PMC: 9332357. DOI: 10.3390/ijerph19159031. View

14.

Marshall R, Haas P, Schweinfurth J, Replogle W . Tracheotomy Outcomes in Super Obese Patients. JAMA Otolaryngol Head Neck Surg. 2016; 142(8):772-6. DOI: 10.1001/jamaoto.2016.1089. View

15.

Murono S, Kei Kakinouchi , Imaizumi M, Nomoto M, Suzuki M . Decannulation after cricotracheostomy: a comparison of partial cricoid cartilage resection with conventional tracheostomy. Acta Otolaryngol. 2021; 141(4):403-407. DOI: 10.1080/00016489.2021.1871645. View

16.

Sugaya T, Ueha R, Sato T, Goto T, Yamauchi A, Yamasoba T . Safety of surgical tracheostomy under continued antithrombotic therapy: A retrospective cohort study. Clin Otolaryngol. 2021; 47(1):88-93. DOI: 10.1111/coa.13861. View

17.

Clark M, Greene S, Reed M . Tracheostomy in critical ill morbidly obese. Crit Care Clin. 2010; 26(4):669-70. DOI: 10.1016/j.ccc.2010.09.003. View

18.

Bennett J . High tracheostomy and other errors--revisited. J Laryngol Otol. 1996; 110(11):1003-7. DOI: 10.1017/s0022215100135625. View