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Is Tracheal Stenosis Caused by Percutaneous Tracheostomy Different From That by Surgical Tracheostomy?^*

^* From Anaesthesia and Intensive Care Medicine (Drs. Raghuraman, Smith, and Mullhi), Thoracic Surgery (Dr. Marzouk), and Cardiothoracic Surgery (Dr. Rajan), Departments of Anaesthesia and Thoracic Surgery, Birmingham Heartlands Hospital, Birmingham Heartlands and Solihull NHS Trust (Teaching), Bordesley Green East, Birmingham, UK.

Correspondence to: Fang G. Smith, MBBS, Birmingham Heartlands Hospital, Birmingham Heartlands and Solihull NHS Trust (Teaching), Bordesley Green East, Birmingham, B9 5SS, UK; e-mail: f.g.smith{at}bham.ac.uk

Study objective: To compare the surgical findings of tracheal stenosis caused by percutaneous tracheostomy (PCT) and surgical tracheostomy (SGT).

Design and setting: A combined prospective (from 2001 to 2003) and retrospective (from 1993 to 2001) observational study of the patients undergoing tracheal resection and reconstruction for treatment of tracheal stenosis following PCT or SGT in a national referral center for thoracic surgery in the United Kingdom.

Patients and measurements: We studied 29 patients presenting with symptomatic tracheal stenosis requiring tracheal reconstruction. We recorded the demographic data, duration of mechanical ventilation, onset of tracheal stenosis after decannulation, and type of tracheostomy (PCT or SGT) from referral notes. Tracheal reconstruction was preceded by rigid bronchoscopy, through which the distance of the superior level of stenosis to the vocal cords, and the length and the diameter of stenosis were measured. The type of surgical technique for tracheal resection was also recorded. We then compared the stenosis caused by PCT (n = 15) and SGT (n = 14) using an unpaired t test, Mann-Whitney U test, or Fisher exact test as appropriate for statistical analysis.

Results: The mean distance from the superior level of stenosis in the PCT group was significantly closer to the vocal cords compared with the mean distance in the SGT group: 1.6 cm (95% confidence interval [CI], 1.1 to 2.1) vs 3.4 cm (95% CI, 2.3 to 4.5), respectively (p = 0.04). The mean onset of stenosis was significantly earlier in the PCT group compared to the SGT group: 5.0 weeks (95% CI, 5.0 to 6.0) vs 28.5 weeks (95% CI, 12 to 84), respectively (p = 0.009). Seven of 15 patients in the PCT group required partial cricoid resection and a mucosal flap, compared with 1 of 14 patients in the SGT group, although the difference did not reach statistic significance (p = 0.23).

Conclusion: Stenosis caused by PCT occurred earlier and was subglottic in nature compared to that by SGT. Surgical correction of stenosis was more difficult in the PCT group due to its presentation in the subglottic area.

Key Words: percutaneous tracheostomy • subglottic stenosis • surgical tracheostomy