Tracheostomy vs. Delayed Extubation in Head and Neck Reconstruction: A Meta-Analysis.

OBJECTIVE

High volume centers are trialing delayed extubation (DE) as an alternative management strategy to tracheostomy in patients undergoing head and neck reconstruction to bypass the pharyngolaryngeal oedema and ensure unobstructed ventilation. There remains a paucity of synthesized evidence in this area.

DATA SOURCES: This study represents the largest systematic review on this topic from databases including PubMed, Embase, and Scopus.

REVIEW

METHODS

Review is conducted through JBI's methodology for systematic reviews of effectiveness with findings reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. A meta-analysis was conducted using the Mantel-Haenszel statistical method with risk ratios and 95% confidence intervals calculated.

RESULTS

For tracheostomy patients, weighted mean hospital and intensive care stay was 13.3 and 1.83 days respectively. For DE, the results were 12.25 and 1.47 days respectively. Meta-analysis for airway complications was statistically significant with a risk ratio of 4.14 (95% CI, 2.67-6.40) favoring the DE group. Risk ratio for flap complications was significant at 8.19 (95% CI, 3.41-19.65) favoring the DE group. One study reported overall survival and disease-free survival at 88.2% and 68.3% for tracheostomy group respectively, compared to 95.7% and 89.1% in the DE cohort.

CONCLUSION

Tracheostomy can no longer be considered routine and poses risks which should be considered in a shared decision-making model with the patient and assessed within a multidisciplinary setting. This study also highlights the emergence of DE, which can be considered in select patient populations. Further RCTs are required in this area.