(A604) Predictors of Tracheostomy in Patients Undergoing Upper Aerodigestive Tract Reconstruction by Free Flap

Introduction: The objective of this study is to identify predictors of tracheostomy in patients undergoing aerodigestive tract reconstruction with a free flap following cancer resection surgery.

Methods: Adults who underwent aerodigestive cancer reconstruction surgery by free flap at a tertiary care safety net hospital from February 2016 to September 2021 were included. Patients who underwent laryngectomy or cutaneous reconstruction were excluded. Patients received placement of a tracheostomy during reconstruction or were kept intubated in the ICU following surgery. Predictive measures included age, sex, BMI, smoking history, Mallampati score, mandibulectomy, and neck dissection. The primary outcome measure was placement of a tracheostomy. Complications associated with tracheostomies were also recorded. Univariate and multivariable analyses were conducted to identify associations between tracheostomy status and predictors of tracheostomy.

Results: In this study, 76 total patients were included, 61 (80.3%) who received tracheostomy and 15 (19.7%) who did not receive tracheostomy. Patients who underwent mandibulectomy (B = 2.943, p = 0.031) were significantly more likely to require a tracheostomy. Neck dissection was marginally significant, with bilateral dissection (B = 4.916, p = 0.067) associated with an increased likelihood of tracheostomy. Other factors, including sex, smoking status, BMI, and Mallampati classification did not show statistically significant effects on tracheostomy rates. Of the patients that underwent tracheostomy, 12 (19.7%) had mucus plugs. Other complications of tracheostomy were infrequent in this population.

Conclusions: The primary predictors of tracheostomy were need for bilateral neck dissection and need for mandibulectomy. These predictors may serve to guide patient selection for tracheostomy at other institutions.