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Safety of surgical tracheostomy under continued antithrombotic therapy

Abstract Objective: Although various guidelines have been established
for the management of antithrombotic therapy during surgical treatments,
surgical tracheostomy (ST) under continued antithrombotic therapy (CAT)
remains a challenge. We investigated the risk factors for complications
after ST by focusing on CAT use during ST. Method: Patients’ medical
records from 2009 to 2020 were reviewed in this retrospective study. We
selected patients who underwent ST at the Department of Otolaryngology
of the University of Tokyo Hospital. Patient demographics,
complications, and blood test values were recorded and statistically
analyzed to identify the risk factors for postoperative complications.
Results: We identified 288 patients (median age: 64 years; 184 men
[64%]), among whom 40 (median age: 67 years; 29 men [73%])
underwent CAT. Although the patients undergoing CAT had significantly
higher values of activated partial thromboplastin time (p = 0.002) and
prothrombin time-international normalized ratio (p = 0.006) than those
of antithrombotic naïve patients, no statistically significant
intergroup differences were observed in the risks of bleeding,
infection, or subcutaneous emphysema. Instead, ST under local anesthesia
(p = 0.01) and ST for airway emergency (p = 0.02) significantly
increased the risk of early postoperative complications. Conclusion: The
results of the present study suggest that ST under CAT can be safely
performed without any increased risk of postoperative complications.
Nevertheless, surgeons should be extra cautious about early
complications after ST under local anesthesia without intubation or ST
for airway emergency. Key points: 1. We aimed to investigate the risk
factors for complications after ST by focusing on CAT use during ST. 2.
Patients undergoing CAT had significantly higher values of APTT and
PT-INR than those of antithrombotic naïve patients. 3. ST under CAT can
be safely performed without any increased risk of postoperative
complications. 4. ST under local anesthesia and airway emergency was a
risk factor for complications after ST. 5. Among the complications,
subcutaneous emphysema was significantly more frequent in ST under local
anesthesia and under airway emergency.