Tracheostomy in bilateral neck dissection: Comparison of three tracheostomy scoring systems

OBJECTIVES: To evaluate whether elective tracheostomy is justified after tumor resection and bilateral neck dissection (ND) and whether application of tracheostomy scoring systems is reliable for planning of postoperative airway management. STUDY DESIGN: Retrospective cohort study. METHODS: We retrospectively assessed airway management in 160 patients with head and neck squamous cell carcinomas. Additionally, we applied and analyzed the 1) Cameron, 2) TRACHY, and 3) CASST tracheostomy scoring systems on the tracheostomy recommendations. RESULTS: Elective tracheostomies were performed in 51.3% of our patients, particularly in T3 to T4 tumors, cases with free flap reconstruction, and concurrent procedures. Among patients undergoing concurrent procedures, those who received tracheostomy showed significantly longer inpatient stays (27.8 ± 30.0 days vs. 13.3 ± 6.6 days; P < 0.001). Tracheostomy recommendation coincides with the performance of bilateral ND in 28.6% (CASST), 60.0% (Cameron), and 75.0% (TRACHY) of the cases, respectively. By applying corresponding criteria, tracheostomy would be recommended in 2.5% (CASST), 76.9% (Cameron), and 84.4% (TRACHY) of our cases. Bleeding episodes were the most common complication occurring in 10 patients (6.3%), but tracheostomy scores did not significantly differ between bleeders and nonbleeders. CONCLUSION: Bilateral ND on its own is not a reliable predictor for elective tracheostomy. Furthermore, given the significant heterogeneity of currently available scoring systems, they prove inadequate for decision making and predictive modeling of tracheostomy placement. LEVEL OF EVIDENCE: 4 Laryngoscope, 2019.