Comparison of Outcomes between Vertical and Horizontal Tracheostomy Incisions: A Randomized Controlled Trial
Main Article Content
Abstract
Background
Tracheostomy is a procedure for patients requiring prolonged mechanical ventilation, airway obstructions, or individuals unable to clear secretions effectively. Otolaryngologists typically perform tracheostomies using two incisions: vertical and horizontal. However, outcome data comparing these techniques in Thailand remain inconclusive.
Objectives
This study aims to determine and compare the results of vertical and horizontal tracheostomy incisions and to display the factors affecting the success of tracheostomy.
Study design
A Randomized Controlled Trial
Material and methods
Fifty-one participants were randomly assigned to vertical incision (n=26) and horizontal incision (n=25). Data collection included demographic information, intraoperative details, and follow-up at 7 days and 3–6 months post-surgery.
Results
Among the 51 patients, 26 underwent vertical and 25 horizontal incisions. At 7 days post-surgery, postoperative bleeding complications occurred in the vertical incision group: one case (3.8%) of grade 2 bleeding (2.5–10 ml) and one case (3.8%) of grade 3 bleeding (10–100 ml). No bleeding was observed in the horizontal group, though differences were not statistically significant (p=0.368). Stomal infection was seen in one case (4%) in the horizontal group and none in the vertical group, without statistical significance (p=0.303). Both groups exhibited 100% wound healing by day 7. At the 3 to 6-month follow-up, one case of stomal infection (14.3%) was reported in the vertical group and none in the horizontal group (p=0.197). Positioning the patient in a hyperextended neck significantly reduced procedure time with a coefficient = -0.3026 (p=0.0309). Additionally, a larger incision size was associated with an increased procedure time with a coefficient = 0.3755 (p=0.0066). Furthermore, early tracheostomy could reduce hospitalization.
Conclusion
This study determined significantly different variables, including the hyperextended neck position, which reduced operative time, and the larger surgical incisions, which increased operative time. Moreover, the early tracheotomy minimized hospitalization.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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