Risk factors for early complications of tracheostomes at Kenyatta National Hospital

Abstract

Background: A tracheostomy is a surgical intervention that can mean the difference between life and death. It has been practiced for thousands of years. The operation is associated with various complications the commonest of which are haemorrhage. surgical emphysema and pneumothorax. The aim of this study was to identify risk factors that contribute to complications following tracheostomies. Research Question: What are the determinants of early cornpl ications In patients undergoing tracheostomy in Kenyatta National Hospital (KNH)? Objective: To establish the determinants of early complications following tracheostomies at KNH. Study Design: This was a prospective cohort study. The study followed up Ior 7 days all in¬patients who had undergone tracheostomy to determine the risk and risk factors for complications amongst this inpatient group. Study site: This study was conducted in KNH situated in the city of Nairobi. KNH is a teaching hospital that sits at the apex of the pyramidal referral system in the Kenyan health sector. Study population: All patients undergoing tracheostomy in KNH during the study period of October 20 I 0 to March 20 II, a total of 100 patients were recruited. Outcome Variables: The outcome variables of each patient were the occurrence of complications following tracheostomy. These were related to the presumed risk factors. Data collection and analysis: Data was collected by the principal investigator and research assistants using a questionnaire. Descriptive statistics and prevalence estimates (with 95% confidence intervals). The data was analyzed using logistic regression for the various outcomes (intraoperative, post operative whether intra/post operative complication).Variables that were significant at 5% level from the univariable analysis were entered into the respective final multivariable models. Sex and age of patient, whether surgery was elective or emergency, whether surgery was performed under general or local anaesthesia, whether the cond ition was obstructive or not, site where surgery was performed and, the surgeon who performed the surgery were included in all the final models appropriately. Discussion: One hundred patients who underwent tracheostomy in Kenyatta National Hospital were recruited into the study. The age ranged from one year old to eighty nine years old. In the study, 71100 patients died; 4 of these patients' deaths were as a result of decannulation of their tracheostomy tube peri-operatively. Prevalence of intraoperative complications was 23% (95 % CI 14.61, 31.39) while that of post operative complications was 42% (95% CI 32.16, 51.84). These estimates were higher than those previously obtained in a retrospective study in the same institution. Excessive bleeding during the operation was the most common complication (2 III 00). The most common complications postoperatively were: pneumonia (17/ 100), emphysema (1511 00) and infection of the tracheostomy site (10/1 00). Interestingly, the study found a significant increase in morbidity with increasing age of the patient and in patients who had neck masses. Tracheostomies done in the operating room and those performed in ICU had no significant difference in complications. Moreover, no significant difference in complications was seen in patients whose tracheostomy was performed by residents visa vie consultants. Conclusion and Recommendations: The prevalence of complications following tracheostomies in this study was comparable with the findings from other studies. The study put to rest fears of higher risks to the patients undergoing tracheostomy in lCU as no significant difference was noted in this group. It was also encouraging to note that the learning curve for residents learning and performing the surgery was not as steep as expected. The importance of properly trained staff in perioperative care of patients post tracheostomy cannot be over emphasized. This is both in the operating room and lCU setting. The introduction of percutaneous dilatational tracheostomy technique in our setup is also likely to decrease complications and also improve the performance of tracheostomies in the institution.