Airway Management in Microvascular Reconstruction of the Oral Cavity: Is Immediate Extubation Possible?

Background

A tracheostomy is routinely performed following free tissue transfer (FTT) for oral cavity reconstruction; however, its avoidance whenever possible is advocated to enhance patient recovery and reduce hospital length of stay (LOS).

Purpose

This study aims to measure and compare clinically relevant outcomes for patients who have endotracheal intubation versus tracheostomy for FTT for oral cavity reconstruction.

Study Design, Setting, Sample

A retrospective cohort study was conducted to evaluate subjects undergoing FTT of the oral cavity for benign and malignant pathology at the University of Alabama at Birmingham from 2014 to 2021. Subjects with unresectable tumors or defects that were not primarily located in the oral cavity were excluded.

Independent Variable

The independent variable was perioperative airway management and was divided into 2 groups: 1) endotracheal intubation or 2) tracheostomy.

Main Outcome Variable(s)

The main outcome measure was defined as a postoperative airway-related complication and required escalation of care to an intensive care unit. LOS and surgical complications were also analyzed.

Covariates

The covariates were classified as demographic, medical, pathologic, and operative.

Analyses

Bivariate and multivariate statistical analyses were conducted to compare the outcomes between subjects who were immediately extubated and tracheotomized. Subject demographics and operative parameters were also analyzed.

Results

A total of 560 subjects met the inclusion criteria, with 122 subjects in the immediate extubation group and 438 subjects in the tracheostomy group. The mean age was 59.7 ± 16.3 years in the immediate extubation group and 59.3 ± 13.8 years in the tracheostomy group (P = .8). The proportion of males was 57.4% in the immediate extubation group and 60% in the tracheostomy group (P = .6). No postoperative airway-related complications occurred in the endotracheal intubation group. After controlling for confounding factors, tobacco use was associated with airway-related complications (odds ratio [OR]: 2.66; 95% confidence interval: 1.1-6.3; P = .03). LOS was shorter in the endotracheal intubation versus tracheostomy group (6.8 vs 9 days, P < .01).

Conclusion and Relevance

In subjects who underwent FTT for oral cavity reconstruction, postoperative airway-related complications were associated with a tracheostomy and tobacco use status.