Factors Influencing Time-to-OR for Urgent Tracheotomy: A Scoping Review.

OBJECTIVE

To identify factors influencing time-to-operating room and time-to-airway intervention in urgent tracheotomy and synthesize strategies to reduce delays in airway emergencies.

METHODS

A scoping review was conducted following the Joanna Briggs Institute framework and reported according to PRISMA-ScR guidelines. MEDLINE, Embase, Scopus, Web of Science, and Google Scholar were searched from inception to June 2024. Eligible studies involved adults (≥18 years) undergoing urgent tracheotomy for airway obstruction due to malignancy or infection. Trauma, angioedema, laryngotracheal stenosis, post-radiation edema, and vocal fold paralysis were excluded to reduce heterogeneity and focus on institutional/system-level factors.

RESULTS

Of 1339 records identified, 3 studies (n = 531 patients) met the inclusion criteria. Dyspnea and stridor were the most common presenting symptoms. Malignancy and deep neck infection accounted for most indications. Reported delays were related to operating room access, staffing shortages, and coordination challenges. Complication rates ranged from 8% to 28%, with hemorrhage and infection most frequent; no deaths were directly attributed to tracheotomy. Decannulation rates were higher in non-malignant than in malignant cases.

CONCLUSIONS

Urgent tracheotomy for airway obstruction due to malignancy or infection is time-sensitive, with delays shaped by institutional barriers. Standardized protocols, improved staffing, simulation-based training, and rapid-response teams represent actionable strategies to enhance airway emergency readiness and outcomes.