Tracheostomy in surgical practice: experience in a Nigerian tertiary hospital.

Background: Tracheostomy continues to be a standard surgical procedure for airway management. Objective: This study was conducted to evaluate the indications, and complications associated with the utilization of open surgical tracheostomy in our center. Design and Setting: It is a retrospective study of all patients that had open surgical tracheostomy at the Obafemi Awolowo University Teaching Hospital, Ile-Ife. Nigeria during a 15-year period between January 1986 and December 2000. Patients and methods: The medical records of the forty-four patients that had open surgical tracheostomy in the operating theatre within the study period were evaluated. Results: There were 12 females and 32 males. The mean age was 33.6+ 24.8 years. The indications for tracheostomy were trauma (n =15), infections (n = 13), laryngeal (benign and malignant) tumors (n = 9), other head and neck malignancies (n = 4), neurological cases with respiratory failure (n = 2), and tracheomalacia (n = 1). All the tracheostomies were performed as an emergency as all the patients presented in respiratory obstruction. Transverse incision was employed in n = 35 cases, while the longitudinal incision was employed in n = 3 and the type of incision was not specified in the remaining six cases. Laryngeal stenosis was found in 6.9% of cases and the mortality was 25%. Conclusion: Upper airway obstruction was the major indication for tracheostomy in our center; and the high mortality may be due to the primary medical problems rather than the complications of tracheostomy alone. Key Words: Open surgical tracheostomy, Indications, Complications. Resume Introduction: La tracheostomie continue d'etre un protocole chirurgical de reference en ce qui est de la prise en charge des bronches. Objectif: Cet etude a ete effectuee afin d'evaluer des indications, et des complications associees avec l'utilisation de la tracheostomie chirurgicale ouverte dans notre centre. Plan et Cadre:C'est une etude retrospective de tous les patients qui avaient subi la tracheostomie chirurgicale ouverte au centre hospitalier universitaire d'Obafemi Awolowo, Ile-Ife, Nigeria au cours d'une duree de 15ans entre janvier 1986 au decembre 2000. Patients et Methodes: Les dossiers medicaux de quarante quatre malades qui avaient eu la tracheostomie chirugicale ouverte dans la salle d'operation pendant la periode d'etude ont ete evalues. Resultats: II y avait 12 femmes et 32 hommes. L'âge moyen etait 33,6+ =24,8 ans. Les indications pour la tracheostomie etaient: traumatisme (n = 15), infections (n = 13), laryngite (benigne et maligne), tumeurs (n= 9), des autres malignites de la tete et du cou (n = 4), des cas neurologiques avec l'insuffissance respiratoire (n = 2), et la tracheomalacie (n = 1). Toutes les tracheostomies ont ete operees comme d'urgence parce que tous les patients etaeint atteints d'obstruction respiratoire. L'incision transversale etait utilisee en n = 35 des cas, tandis que l'incision longitudinale etait utilisee en n = 3 et le type d'incision n'etait pas precise dans les autres six cas. La stenose laryngite etait trouvee en 6,9% des cas et la mortalite etait 25%. Conclusion: L'obstruction des bronches superieures etait l'indication majeure pour la tracheostomie dans notre centre, et le taux eleve de la mortalite pourrait etre attributable aux problemes medicaux primaire plutot que des complication de la tracheostomie seulement. West African Journal of Medicine Vol.23(1) 2004: 32-34