Comparison of criteria for elective tracheostomy in head and neck cancer surgery

Elective tracheostomy before resection of a malignancy in head and neck region assures unobstructed ventilation during postoperative period but is associated with an increased risk of complications. We aimed to evaluate retrospectively, how the application of elective tracheostomy scales would influence the frequency of tracheostomy in comparison with preoperative clinical judgement. In 205 patients operated on from 2013 till 2017, theresection of a malignancy involved suprahyoid or pharyngeal muscles, neck dissection and flap reconstruction. The decision on elective tracheostomy was made on the clinical basis. Score for each patient in 3 published scales was calculated. In the study group 76 patients had elective tracheostomy at the outset of a resection procedure. Among 129 patients without elective tracheostomy, 9 had tracheostomy in the postoperative period. Indications for elective tracheostomy were calculated for scale I, II and III. Only in 120 patients the decision whether to perform elective tracheostomy would be identical in each scale. Our results suggest that decisions to perform elective tracheostomy based on 3 scales show low specificity. The factors used in the published scales should be evaluated in a prospective multicenter study