Kevin M Higgins1, Xerxes Punthakee. 1. Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre-University Toronto, Ontario, Canada. Kevin.higgins@sunnybrook.ca
Abstract
OBJECTIVES/HYPOTHESIS: Multiple studies have been performed to characterize differences in complications and cost-effectiveness of open and percutaneous tracheostomy; however, large enough studies have not been performed to determine a clearly superior method. Our primary objective was to compare complication rates of open versus percutaneous tracheostomy in prospective, randomized-controlled trials using meta-analysis methodology. Secondary objectives included cost-effectiveness and procedure length analyses. STUDY DESIGN: Meta-analysis. METHODS: From 368 abstracts, 15 prospective, randomized-controlled trials involving nearly 1,000 patients were reviewed to extract basic demographic data in addition to complications, case length, and cost-effectiveness. Pooled odds ratios (OR) with confidence intervals (CI) were calculated in addition to subgroup analyses and meta-regression. RESULTS: Pooled OR revealed statistically significant results against percutaneous tracheostomy for the complication of decannulation/obstruction (OR 2.79, 95% CI 1.29-6.03). There were significantly fewer complications in the percutaneous group with respect to wound infection (0.37, 0.22-0.62) and unfavorable scarring (0.44, 0.23-0.83). There was no statistically significant difference for complications of false passage (2.70, 0.89-8.22), minor hemorrhage (1.09, 0.61-1.97, P = .77), major hemorrhage (0.60, 0.28-1.26), subglottic stenosis (0.59, 0.27-1.29), death (0.70, 0.24-2.01), and overall complications (0.75, 0.56-1.00). However, the overall complications trended toward favoring the percutaneous technique. Percutaneous tracheostomy case length was shorter overall by 4.6 minutes, and costs were less by approximately $456 USD. CONCLUSIONS: Our meta-analysis illustrates there is no clear difference but a trend toward fewer complications in percutaneous techniques. Percutaneous tracheotomies are more cost-effective and provide greater feasibility in terms of bedside capability and nonsurgical operation.
OBJECTIVES/HYPOTHESIS: Multiple studies have been performed to characterize differences in complications and cost-effectiveness of open and percutaneous tracheostomy; however, large enough studies have not been performed to determine a clearly superior method. Our primary objective was to compare complication rates of open versus percutaneous tracheostomy in prospective, randomized-controlled trials using meta-analysis methodology. Secondary objectives included cost-effectiveness and procedure length analyses. STUDY DESIGN: Meta-analysis. METHODS: From 368 abstracts, 15 prospective, randomized-controlled trials involving nearly 1,000 patients were reviewed to extract basic demographic data in addition to complications, case length, and cost-effectiveness. Pooled odds ratios (OR) with confidence intervals (CI) were calculated in addition to subgroup analyses and meta-regression. RESULTS: Pooled OR revealed statistically significant results against percutaneous tracheostomy for the complication of decannulation/obstruction (OR 2.79, 95% CI 1.29-6.03). There were significantly fewer complications in the percutaneous group with respect to wound infection (0.37, 0.22-0.62) and unfavorable scarring (0.44, 0.23-0.83). There was no statistically significant difference for complications of false passage (2.70, 0.89-8.22), minor hemorrhage (1.09, 0.61-1.97, P = .77), major hemorrhage (0.60, 0.28-1.26), subglottic stenosis (0.59, 0.27-1.29), death (0.70, 0.24-2.01), and overall complications (0.75, 0.56-1.00). However, the overall complications trended toward favoring the percutaneous technique. Percutaneous tracheostomy case length was shorter overall by 4.6 minutes, and costs were less by approximately $456 USD. CONCLUSIONS: Our meta-analysis illustrates there is no clear difference but a trend toward fewer complications in percutaneous techniques. Percutaneous tracheotomies are more cost-effective and provide greater feasibility in terms of bedside capability and nonsurgical operation.