Tracheotomy and the role of postoperative chest radiography in adult patients.

A retrospective review of 100 adult tracheotomies performed by the University of Washington Department of Otolaryngology-Head and Neck Surgery was done to evaluate our complication rate and the role of postoperative chest radiography (CXR). In an attempt to identify specific risk factors for pneumothorax (PTX), the following items were reviewed: age, urgency (elective, urgent, and emergent), awake or general anesthesia, diagnosis (reason for tracheotomy), "difficulty" of tracheotomy, postoperative signs or symptoms of PTX, and findings on postoperative CXR. The series had a PTX rate of 2%. Both patients with complications reviewed here had definite risk factors, or signs and symptoms of PTX. The causes, risk factors, and treatments for PTX are reviewed. Postoperative CXR is indicated in cases at increased risk for PTX, and in patients with clinical signs or symptoms of PTX. Had we followed our proposed criteria, we would have performed postoperative CXR 13 times instead of 93. This would have resulted in a total savings of $10,020. We conclude that postoperative CXR after a routine, uncomplicated tracheotomy is of low yield and incurs unnecessary expense.