Site of Tracheostomy and Its Influence on The Surgical Outcome and Quality of Life After Tracheal Resection and Anastomosis in Patients with Tracheal Stenosis

Pradeep, Soorya; Alexander, Arun; Ganesan, Sivaraman; Srinivasan, Dharanya Gopalakrishnan; Kushwaha, Akshat; Gopalakrishnan, Aparna; Penubarthi, Lokesh Kumar; Raja, Kalaiarasi; Saxena, Sunil Kumar

doi:10.1055/S-0043-1776702

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International Archives of Otorhinolaryngology

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Original Research • iao 28 (1) • 2024 • https://doi.org/10.1055/S-0043-1776702 copy

Site of Tracheostomy and Its Influence on The Surgical Outcome and Quality of Life After Tracheal Resection and Anastomosis in Patients with Tracheal Stenosis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

With the advances in critical care, the incidence of post intubation tracheal stenosis is increasing. Tracheal resection and anastomosis have been the gold standard for the management of grades III and IV stenosis. Scientific evidence from the literature on the determining factors and outcomes of surgery is not well described.

Objective

This study was aimed at determining the influence of tracheostoma site on the surgical outcomes and postoperative quality of life of patients undergoing tracheal resection anastomosis.

Methods

Thirteen patients who underwent tracheal resection and anastomosis during a period of 3 years were followed up prospectively for 3 months to determine the degree of improvement in their quality of life postsurgery by comparing the pre and postoperative validated Tamil/vernacular version of RAND SF-36 scores and Medical Research Council (MRC) dyspnea score.

Results

As per preoperative computed tomography (CT), the mean length of stenosis was found to be 1.5 cm while the mean length of trachea resected was 4.75 cm. We achieved a decannulation rate of 61.53%. There was an estimated loss of 3.20 +/– 1.90 cm of normal trachea from the lower border of the stenosis until the lower border of the stoma that was lost during resection.

Analysis of SF-36 and MRC dyspnea scores revealed significant improvement in the domains of physical function postoperatively in comparison with the preoperative scores (p < 0.05).

Conclusion

Diligent placement of tracheostomy in an emergency setting with respect to the stenotic segment plays a pivotal role in minimizing the length of the resected segment of normal trachea.

Keywords
trachea; tracheostomy; dyspnea; airway management

Demographic and clinical characteristics	Frequency	Percentage
Age(years)
Mean ± SD	23.69 ± 4.9
Median (25th–75th percentile)	24(20–25)
Range	19–36
Gender
Female	5	38.46%
Male	8	61.54%
Occupation
Housewife	2	15.38%
Laborer	1	7.69%
Mason	1	7.69%
Mechanic	2	15.38%
Student	7	53.85%

CT parameters	Mean ± SD	Median (25th–75th percentile)	Range
Length of stenosis (cm)	1.68 ± 1.09	1.4(0.9–2)	0.8–4.8
Minimum diameter of stenotic segment (cm)	0.4 ± 0.3	0.5(0–0.6)	0–0.8
Distance from cricoid (cm)	0.75 ± 1.28	0.9(0.6–1.36)	–2.97–2.32
Preoperative estimation of length of trachea to be resected (cm)	4.75 ± 1.41	4.82 (3.57–5.7)	2.59–7.04

CT parameters	Decannulation (n = 8)	No decannulation (n = 5)	Total	P-value	Odds ratio (95% CI)
Length of stenosis(cm)	1.81 ± 1.3	1.48 ± 0.74	1.68 ± 1.09	0.621*	1.178 (0.387–3.587)
Minimum diameter of stenotic segment (cm)	0.43 ± 0.29	0.36 ± 0.36	0.4 ± 0.3	0.724*	1.934(0.042–88.436)
Distance from cricoid (cm)	0.85 (0.507–1.212)	1.1 (0.7–1.36)	0.9 (0.6–1.36)	0.77^†	0.877 (0.34–2.261)
Preoperative estimation of length of trachea to be resected(cm)	4.57 ± 1.1	5.03 ± 1.92	4.75 ± 1.41	0.592*	0.813 (0.354–1.866)

MRC dyspnea and its components	Mean ± SD	Median (25th–75th percentile)	Range	P-value
MRC dyspnea
Preoperative	3.62 ± 1.19	4 (2.75–4.25)	2–5	0.016^§
Postoperative	1.5 ± 0.53	1.5 (1–2)	1–2	0.016^§
Physical function
Preoperative	54.38 ± 21.62	62.5 (50–66.25)	10–75	0.016^§
Postoperative	78.75 ± 28.25	87.5 (83.75–91.25)	10–95	0.016^§
Role limitation due to physical health
Preoperative	18.75 ± 29.12	0 (0–31.25)	0–75	0.025^§
Postoperative	81.25 ± 37.2	100 (87.5–100)	0–100	0.025^§
Role limitation due to emotional problems
Preoperative	62.5 ± 41.55	66.67 (33.333–100)	0–100	0.059^§
Postoperative	91.67 ± 15.43	100 (91.667–100)	66.67–100	0.059^§
Fatigue
Preoperative	48.12 ± 22.98	57.5 (27.5–65)	15–75	0.778^§
Postoperative	46.25 ± 5.18	50 (40–50)	40–50	0.778^§
Emotional wellbeing
Preoperative	58.5 ± 15.11	58 (51–69)	32–80	0.125‡
Postoperative	70 ± 8.82	72 (66–73)	56–84	0.125‡
Social functioning
Preoperative	64.06 ± 24.49	62.5 (50–78.125)	25–100	0.034^§
Postoperative	92.19 ± 22.1	100 (100–100)	37.5–100	0.034^§
Bodily pain
Preoperative	78.12 ± 25.31	88.75 (53.125–100)	45–100	0.497^§
Postoperative	85.62 ± 14.93	90 (69.375–100)	67.5–100	0.497^§
General health
Preoperative	38.75 ± 24.89	30 (20–57.5)	10–80	0.003^‡
Postoperative	77.5 ± 8.86	77.5 (73.75–80)	65–95	0.003^‡

STUDY	n	MEAN LENGTH RESECTED (Range/mean) (cm)	GRANULATION (%)	RESTENOSIS (%)	DEHISCENCE (%)	DURATION OF FOLLOW-UP (years)	DECANNULATIONRATE (%)	POSTOPERATIVE DILATION (%)	T-TUBE (%)	REVISION SURGERY (%)	MORTALITY (%)
Pearson et al. (1971)³3 Pearson FG, Andrews MJ. Detection and management of tracheal stenosis following cuffed tube tracheostomy. Ann Thorac Surg 1971;12(04):359–374	37	3–5		16.21			89.19			16.21	5.40
Laccourreye et al. (1996)¹¹11 Laccourreye O, Naudo P, Brasnu D, Jouffre V, Cauchois R, Laccourreye H. Tracheal resection with end-to-end anastomosis for isolated postintubation cervical trachea stenosis: long-term results. Ann Otol Rhinol Laryngol 1996;105(12):944–948	32			6.20		5			3.1	3.1
El-Fattah¹²12 El-Fattah AMA, Kamal E, Amer HE, Fouda M, Elwahab AEMA, Tawfik A. Cervical tracheal resection with cricotracheal anastomosis: experience in adults with grade III-IV tracheal stenosis. J Laryngol Otol 2011;125(06):614–619	12	2–4				10	91	16
Wright (2004)¹³13 Wright CD, Grillo HC, Wain JC, et al. Anastomotic complications after tracheal resection: prognostic factors and management. J Thorac Cardiovasc Surg 2004;128(05):731–739	900	3.3	8.6	45.6	45.6		95	0.2	4	1.7	1.2
Bibas et al. (2014)¹⁴14 Bibas BJ, Terra RM, Oliveira Junior AL, et al. Predictors for postoperative complications after tracheal resection. Ann Thorac Surg 2014;98(01):277–282	94	2.9	4	16	1		96.8	12	6.38	1.06	0
H Elsayed (2016)¹⁵15 Elsayed H, Mostafa AM, Soliman S, Shoukry T, El-Nori AA, El-Bawab HY. First-line tracheal resection and primary anastomosis for postintubation tracheal stenosis. Ann R Coll Surg Engl 2016;98(06):425–430	30		8.8				96.7	56.7	Stent 13.3	3.33	3.33
Mohsen et al. (2018)¹⁶16 Mohsen T, Abou Zeid A, Abdelfattah I, Mosleh M, Adel W, Helal A. Outcome after long-segment tracheal resection: study of 52 cases. Eur J Cardiothorac Surg 2018;53(06):1186–1191	52	4.378	–	13.4	0	10	86.5	7.69			0
Piazza et al. (2014)¹⁷17 Piazza C, Del Bon F, Paderno A, et al. Complications after tracheal and cricotracheal resection and anastomosis for inflammatory and neoplastic stenoses. Ann Otol Rhinol Laryngol 2014;123(11): 798–804	137	2.7	14	38	47.6		99				< 1
Mutrie et al. (2011)¹⁸18 Mutrie CJ, Eldaif SM, Rutledge CW, et al. Cervical tracheal resection: new lessons learned. Ann Thorac Surg 2011;91(04):1101–1106, discussion 1106	105	2.7	–	17	1	3	98	17		3	1
D’Andrilli et al. (2016)¹⁹19 D’Andrilli A, Venuta F, Rendina EA. Subglottic tracheal stenosis. J Thorac Dis 2016;8(2, Suppl 2)S140–S147	109	3.4	–	7.4	0.9	4.3	94.5			0	0
Kanlikama et al. (2018)⁷7 Kanlikama M, Celenk F, Gonuldas B, Gulsen S. Cervical Tracheal Resection and Anastomosis for Postintubation Tracheal Stenosis. J Craniofac Surg 2018;29(06):e578–e582	34		(8.8)	32.4	(5.9)	0.5	(91.1)	(8.8)	14.7	14.70	(2.9)
Present study	13	4.75	23.07	15.38	–	0.25	61.53	23.7	15.8	–	0

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[1] Address for correspondence Sivaraman Ganesan, MS, DNB (ENT), FHNO, Additional professor, Department of ENT, JIPMER, Pondicherry, 605006, India (email: gsivram@gmail.com).