Percutaneous dilational tracheostomy following anterior cervical spine fixation - a retrospective propensity-matched cohort study

Ronny Meisterfeld; Anne Queck; Alexander Carl Disch; Marius Distler; Hanns-Christoph Held; Janusz von Renesse; Klaus-Dieter Schaser; Jürgen Weitz; Konrad Kamin

doi:10.1007/s00586-024-08484-3

Percutaneous dilational tracheostomy following anterior cervical spine fixation - a retrospective propensity-matched cohort study

Eur Spine J. 2024 Sep 6. doi: 10.1007/s00586-024-08484-3. Online ahead of print.

Authors

Ronny Meisterfeld^{1

2}, Anne Queck³, Alexander Carl Disch^{4

5}, Marius Distler⁶, Hanns-Christoph Held⁷, Janusz von Renesse⁶, Klaus-Dieter Schaser⁴, Jürgen Weitz⁶, Konrad Kamin⁴

Affiliations

¹ Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany. ronny.meisterfeld@uniklinikum-dresden.de.
² University Centre of Surgery Intensive Care Unit, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany. ronny.meisterfeld@uniklinikum-dresden.de.
³ Department of Medicine I, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany.
⁴ University Centre for Orthopaedics, Traumatology and Plastic Surgery, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany.
⁵ University Comprehensive Spine Center, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany.
⁶ Department of Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany.
⁷ University Centre of Surgery Intensive Care Unit, University Hospital Carl Gustav Carus, University of Technology Dresden, Dresden, Germany.

PMID: 39240289
DOI: 10.1007/s00586-024-08484-3

Abstract

Purpose: In patients with traumatic, infectious, degenerative, and neoplastic surgical indications in the cervical spine, commonly the anterior approach is used. Often these patients require a tracheostomy necessary due to prolonged mechanical ventilation. The limited spinal mobility and proximity to the surgical site of anterior cervical spine fixation (ACSF) could pose an increased risk for complications of percutaneous dilational tracheostomy (PDT.) Importantly, PDT might raise wound infection rates of the cervical spine approach. The aim of this study is to prove safety of PDT after ACSF.

Methods: We performed a retrospective, single-center study comparing patients with and without ACSF who underwent Ciaglia-single step PDT. After propensity score matching using logistic regression, we compared intra- and postprocedural complication rates. Furthermore, surgical site infections were evaluated. Putensen's definitions of complications and Clavien-Dindo's classification were used.

Results: A total of 1175 patients underwent PDT between 2009 and 2021. Fifty-seven patients underwent PDT following ACSF and were matched to fifty-seven patients without ACSF. The mean interval between ACSF and PDT was 11.3 days. The overall complication rate was 19.3% in the ACSF group and 21.1% in the non-ACSF group. The mean follow-up was 388 days (± 791) in the ACSF group and 424 days (± 819) in the non-ACSF group. Life-threatening complications (Clavien-Dindo IV to V) were found in 1.8% of ACSF patients and 3.5% of non-ACSF patients. There were no significant differences in complication rates. No surgical site infection of the anterior spine access was detected.

Conclusion: PDT is a feasible and safe procedure in patients after ACSF. Complication rates are comparable to patients without ACSF. Surgical site infections of ACSF are very rare.

Keywords: Anterior cervical spine fixation; Complication rates; Percutaneous dilational tracheostomy; Surgical site infection; Tracheostomy.