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Percutaneous Versus Surgical Tracheotomy: An Updated Meta‐Analysis
Author(s) -
Oliver Eric R.,
Gist Amber,
Gillespie M Boyd
Publication year - 2007
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 - 10.1097/mlg.0b013e318093edae
Subject(s) - tracheotomy , medicine , confidence interval , randomized controlled trial , odds ratio , percutaneous , meta analysis , surgery , complication
Objective: Perform an updated meta‐analysis investigating differences in complication rates, procedure times, and costs between percutaneous dilational tracheotomy (PDT), operating room surgical tracheotomy (ST), and bedside surgical tracheotomy (BST). Methods: Meta‐analysis using the Mantel‐Haenszel fixed effects model. Prospective and randomized trials comparing ST with PDT from 1999 to present were identified through two independent searches. Outcome measures analyzed included mortality, early complications, late complications, procedure times, and cost. Results: Fourteen studies were identified (1,273 patients) that satisfied the search criteria. Analysis of randomized studies demonstrated significantly more minor early complications with PDT compared with ST (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.01–2.66). Randomized studies comparing PDT with BST demonstrated significantly more early complications with PDT (OR, 4.66; 95% CI, 1.46–14.91). There was no significant difference in late serious complications in studies that randomized patients to ST or PDT (OR, 1.39; 95% CI, 0–16,000). PDT is significantly faster to perform than ST (OR, 0.51; 95% CI, 95% 0.49–0.53). BST and PDT have similar costs, and both are less expensive than ST. Conclusions: Although significantly faster than ST, PDT has more early complications compared with open tracheotomy in the operating room or at the bedside. The long‐term complications of the two techniques appear comparable but have not been thoroughly investigated. These findings suggest that a team approach between surgeons and critical care specialists is essential to select the appropriate tracheotomy technique for a given patient.