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Regarding “ Mortality Associated With Tracheostomy Complications in the United States: 2007–2016 ”
Author(s) -
Klemm Eckart,
Nowak Andreas
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27923
Subject(s) - medicine , otorhinolaryngology , anesthesiology , pain medicine , intensive care , university hospital , emergency department , general surgery , head and neck surgery , head and neck , family medicine , surgery , nursing , psychiatry , intensive care medicine
Cramer et al. deserve thanks for their analysis of tracheotomy-associated deaths based on the death statistics of the Centers for Disease Control and Prevention. The authors identified 623 tracheostomy-related deaths of 25,587,306 total deaths reported and recommended further studies. These data indicate a frequency of 0.0022% of tracheotomy-associated deaths in relation to the number of deaths in the United States for the period of 2007 to 2016. From this data, the incorrect conclusion could be drawn that tracheostomy-related deaths are very rare events. In our systematic review of tracheostomy-related deaths from 1990 to 2015, we found 352 cases of tracheostomy-related deaths in 109 publications from 21 countries with a total of 25,056 tracheostomies. This finding corresponds to a total frequency of fatal events of 1.4%. The detailed analysis of 16,827 percutaneous dilatational tracheostomies (PDT) and 7,934 open surgical tracheostomies (OST) revealed similar frequencies: 113 for PDT, 49 for OST, and 190 without specification of the method. The incidence of death in OST was 0.62% (95% confidence interval [CI] 0.47–0.82%), and the incidence in PDT was 0.67% (95% CI 0.56– 0.81%). Another point of interest is the rate of autopsies in the United States, with 38.5%. In our review, the autopsy rate was 11.4% in tracheotomized patients worldwide, which is why we suspect underreporting in our review. The fact that we found studies of tracheostomy-related deaths published in English, German, French, and Russian languages in only 21 countries also suggests a high level of underreporting. A similar situation was also found in studies by Simon et al. and Brass et al. The current state of knowledge on tracheostomy-related deaths exhibits an overall low quality of evidence. Among the many tracheostomies performed worldwide, it is necessary to focus on possible deaths, their reasons, and methods of avoiding them.