Langenbeck's Archives of Surgery

, Volume 403, Issue 2, pp 137–149 | Cite as

Percutaneous versus surgical strategy for tracheostomy: a systematic review and meta-analysis of perioperative and postoperative complications

  • Rosa Klotz
  • Pascal Probst
  • Marlene Deininger
  • Ulla Klaiber
  • Kathrin Grummich
  • Markus K. Diener
  • Markus A. Weigand
  • Markus W. Büchler
  • Phillip Knebel
Systematic Reviews and Meta-analyses
  • 210 Downloads

Abstract

Purpose

Tracheostomy is one of the most frequently performed procedures in intensive care medicine. The two main approaches are open surgical tracheostomy (ST) and percutaneous dilatational tracheostomy (PDT). This systematic review summarizes and analyzes the existing evidence regarding perioperative and postoperative parameters of safety.

Methods

A systematic literature search was conducted in the Cochrane Library, EMBASE, LILACS, and MEDLINE to identify all randomized controlled trials (RCTs) comparing complications of ST and PDT and to define the strategy with the lower risk of potentially life-threatening events. Risk of bias was assessed using the criteria outlined in the Cochrane Handbook.

Results

Twenty-four citations comprising 1795 procedures (PDT: n = 926; ST: n = 869) were found suitable for systematic review. No significant difference in the risk of a potentially life-threatening event (risk difference (RD) 0.01, 95% CI − 0.03 to 0.05, P = 0.62, I 2 = 47%) was found between PDT and ST. There was no difference in mortality (RD − 0.00, 95% CI − 0.01 to 0.01, P = 0.88, I 2 = 0%). An increased rate of technical difficulties was shown for PDT (RD 0.04, 95% CI 0.01, 0.08, P = 0.01, I 2 = 60%). Stomal infection occurred more often with ST (RD − 0.05, 95% CI − 0.08 to − 0.02, P = 0.003, I 2 = 60%). Both techniques can be safely performed on the ICU. Meta-analysis of the duration of procedure was not possible owing to high heterogeneity (I 2 = 99%).

Conclusion

ST and PDT are safe techniques with low incidence of complications. Both techniques can be performed successfully in an ICU setting. ST can be performed on every patient whereas PDT is restricted by several contraindications like abnormal anatomy, previous surgery, coagulopathies, or difficult airway of the patient.

Systematic review registration

PROSPERO CRD42015021967

Keywords

Tracheostomy Percutaneous dilatational tracheostomy Surgical tracheostomy Systematic review with meta-analysis 

Notes

Authors’ contributions

MAW, MKD, MWB, PK, and RK designed the study. KG, MD, RK, and UK acquired the data; PK, PP, and RK analyzed and interpreted the data. MKD, PK, and RK drafted the manuscript. All authors critically revised the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Supplementary material

423_2017_1648_MOESM1_ESM.doc (22 kb)
ESM 1 (DOC 22 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Rosa Klotz
    • 1
    • 2
  • Pascal Probst
    • 1
    • 2
  • Marlene Deininger
    • 3
  • Ulla Klaiber
    • 1
    • 2
  • Kathrin Grummich
    • 1
  • Markus K. Diener
    • 1
    • 2
  • Markus A. Weigand
    • 4
  • Markus W. Büchler
    • 2
  • Phillip Knebel
    • 1
    • 2
  1. 1.Study Center of the German Surgical Society (SDGC)University of HeidelbergHeidelbergGermany
  2. 2.Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany
  3. 3.Department of Anaesthesiology and Intensive Care Medicine, Division of General Anaesthesiology, Emergency- and Intensive Care MedicineUniversity Hospital Graz, Medical University of GrazGrazAustria
  4. 4.Department of AnesthesiologyUniversity of HeidelbergHeidelbergGermany

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