The Predictors of Persistent Posttracheostomy Tracheocutaneous Fistula and Successful Surgical Closure

Eyal Yosefof*, Nir Tsur, Tomer Boldes, Esmat Najjar, Aviram Mizrachi, Thomas Shpitzer, Yaniv Hamzany, Gideon Bachar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Persistent tracheocutaneous fistula is a well-described complication of prolonged tracheostomy, with a prevalence of about 70% when decannulation is performed after more than 16 weeks. Predictors of its occurrence and outcome of treatment in adults remain unclear. The aim of the study was to describe our experience with the treatment of persistent posttracheostomy tracheocutaneous fistula in adults and to investigate factors associated with its formation and with the success of surgical closure. Study Design: Retrospective cohort. Setting: Tertiary medical center. Methods: Patients who underwent open-approach tracheostomy between 2000 and 2020 were identified by database review. Data on background, need for surgical closure, and the surgical outcome was collected from the medical files and analyzed statistically between groups. Results: Of 516 patients identified, 127 with sufficient long-term follow-up data were included in the study. Compared to patients whose fistula closed spontaneously (n = 85), patients who required surgical closure (n = 42) had significantly higher rates of smoking, laryngeal or thyroid malignancy, and airway obstruction as the indication for tracheostomy, on both univariate and multivariate analysis. In a comparison of patients with successful (n = 29) or failed (n = 11) surgical closure, factors significantly associated with failure were prior radiotherapy and lower preoperative albumin level, on univariate analysis. Conclusion: Smoking, thyroid or laryngeal malignancy, and airway obstruction indication are risk factors for persistent posttracheostomy tracheocutaneous fistula. Patients should be closely followed after tracheostomy and referred for surgery if the fistula fails to close. Before surgery, careful evaluation of the patient's nutritional status and consideration of prior radiation treatment is mandatory.

Original languageEnglish
Pages (from-to)62-68
Number of pages7
JournalOtolaryngology - Head and Neck Surgery
Volume169
Issue number1
DOIs
StatePublished - Jul 2023

Keywords

  • head and neck cancer
  • malnutrition
  • persistent tracheocutaneous fistula
  • radiotherapy
  • tracheostomy

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