Age-Related Complications in Percutaneous Dilational Tracheostomy (PDT) And Traditional Open Surgical Tracheostomy: A Randomized Controlled Trial
Keywords:
Tracheostomy, Percutaneous dilatational tracheostomy, Open surgical tracheostomyAbstract
Background: Tracheostomy is frequently performed on critically ill patients who require continuous ventilatory support. Since open surgical tracheostomy (OST) has been largely replaced by the less invasive percutaneous dilational tracheostomy (PDT), it is important to understand how patient age influences procedural risk, particularly given the aging population.
Methods: In a prospective randomized controlled trial, 220 intensive care unit patients requiring elective tracheostomies were assigned to receive either PDT or OST. Patients were stratified into three age groups: under 50 years, 50-70 years, and over 70 years. The primary outcomes were intraoperative and postoperative complication rates up to 30 days. Multivariate logistic regression was used to identify independent predictors of complications.
Results: The PDT group had lower overall complication rates (14.5%) compared to the OST group (23.6%), although this difference was not statistically significant (p=0.09). Age-stratified analysis revealed that patients over 70 years (16.1% vs. 34.4%, p=0.03) and those aged 50-70 years (12.2% vs. 22.5%, p=0.04) experienced significantly fewer complications with PDT. No significant difference was observed in patients under 50 years. Multivariate analysis identified the use of OST (OR 1.78, p=0.04) and age over 70 years (OR 2.45, p=0.01) as independent predictors of higher complication risk.
Conclusion: PDT is associated with fewer complications than OST in older patients, suggesting age-specific advantages for the less invasive procedure. These findings support the preferential use of PDT in older patients when feasible and underscore the importance of personalized, age-conscious procedural planning in airway management.
References
Moore AWB, Pitts L, Jasahui MP. An updated review in percutaneous tracheostomy. AME Med J. 2024;9:33.
DOI: https://doi.org/10.21037/amj-23-143
Meisterfeld R, Queck A, Disch AC, et al. Percutaneous dilational tracheostomy following anterior cervical spine fixation - a retrospective propensity-matched cohort study. Eur Spine J. 2024;33(10):4012-4019.
DOI: https://doi.org/10.1007/s00586-024-08484-3
Lais G, Vargas M, Buonanno P, et al. Tracheostomy: update on why, when and how. Curr Opin Crit Care. 2025;31(1):101-107.
DOI: https://doi.org/10.1097/MCC.0000000000001224
Sutthipongkiat E, Chumpathong S, Boonmak L, et al. Emergency Tracheostomy: Complications, Anesthetic Techniques, and Outcomes. J Anesth. 2024;38(4):512-520.
DOI: https://doi.org/10.1177/01455613241238620
Rosario E, Ross T, Komorowski M, Tolley N. Coronavirus disease tracheostomy complications: a scoping review. J Laryngol Otol. 2023;137(1):7-16.
DOI: https://doi.org/10.1017/S0022215122002286
Pandit A, Swami G, Kumar KD. Comparative Study of Percutaneous Dilatational Tracheostomy and Conventional Surgical Tracheostomy in Critically Ill Adult Patients. Indian J Otolaryngol Head Neck Surg. 2023;75(3):1568-1572.
DOI: https://doi.org/10.1007/s12070-023-03956-3
Lin KT, Kao YS, Chiu CW, et al. Comparative effectiveness of ultrasound-guided and anatomic landmark percutaneous dilatational tracheostomy: A systematic review and meta-analysis. PLoS One. 2021;16(10):e0258972.
DOI: https://doi.org/10.1371/journal.pone.0258972
Premraj L, Camarda C, White N, et al. Complication Rate of Percutaneous Dilatational Tracheostomy in Critically Ill Adults With Obesity: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. 2023;149(4):334-343.
DOI: https://doi.org/10.1001/jamaoto.2022.4806
Lee SA, Kim JS, Ji M, et al. Optimal methodology for percutaneous dilatational tracheostomy: a comparative analysis between conventional and multidisciplinary approaches utilizing ultrasound, flexible bronchoscopy, and microcatheter puncture in critically ill individuals of diminutive stature. J Thorac Dis. 2024;16(6):3668-3684.
DOI: https://doi.org/10.21037/jtd-24-172
Merola R, Iacovazzo C, Troise S, et al. Timing of Tracheostomy in ICU Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Life (Basel). 2024;14(9):1165.
DOI: https://doi.org/10.3390/life14091165
Battaglini D, Premraj L, White N, et al. Tracheostomy outcomes in critically ill patients with COVID-19: a systematic review, meta-analysis, and meta-regression. Br J Anaesth. 2022;129(5):679-692.
DOI: https://doi.org/10.1016/j.bja.2022.07.032
Erickson MM, Ross B, Shnayder Y, Hartnick CJ. Retrospective review of acute post-tracheostomy complications and contributing risk factors. Clin Otolaryngol. 2024;49(2):197-202.
DOI: https://doi.org/10.1111/coa.14131
Umstot R, Samanta D, Umstot E, Area SA, Richmond BK, Jarrouj A. Ten-Year Review of Tracheostomy Techniques and Related Complications. Angiology. 2024;90(2):225-230.
DOI: https://doi.org/10.1177/00031348231198115
Chong WH, Tan CK. Clinical Outcomes of Early Versus Late Tracheostomy in Coronavirus Disease 2019 Patients: A Systematic Review and Meta-Analysis. J Intensive Care Med. 2022;37(9):1121-1132.
DOI: https://doi.org/10.1177/08850666221098930
Gupta S, Dixit S, Choudhry D, et al. Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations. Indian J Crit Care Med. 2020;24(Suppl 1):S31-S42.
DOI: https://doi.org/10.5005/jp-journals-10071-G23184
Devaraja K, Majitha CS, Pujary K, Nayak DR, Rao S. A Simplified Protocol for Tracheostomy Decannulation in Patients Weaned off Prolonged Mechanical Ventilation. Int Arch Otorhinolaryngol. 2024;28(2):e211-e218.
DOI: https://doi.org/10.1055/s-0043-1772596
Vargas M, Battaglini D, Antonelli M, et al. Follow-up short and long-term mortalities of tracheostomized critically ill patients in an Italian multi-center observational study. Sci Rep. 2024;14:2319.
DOI: https://doi.org/10.1038/s41598-024-52785-y
Strober W, Kallogjeri D, Piccirillo JF, Rohlfing ML. Tracheostomy Incidence and Complications: A National Database Analysis. Otolaryngol Head Neck Surg. 2024;171(5):1379-1386.
DOI: https://doi.org/10.1002/ohn.843
Mussa CC, Gomaa D, Rowley DD, et al. AARC clinical practice guideline: management of adult patients with tracheostomy in the acute care setting. Respir Care. 2021;66(1):156-169.
DOI: https://doi.org/10.4187/respcare.08206
Moser B, Auinger K, Weiss G, et al. Prevention of Tracheostomy-Related Pressure Injury: A Systematic Review and Meta-analysis. Am J Crit Care. 2022;31(6):464-473.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Sultan Ahmad, Imran Bashir, Hafiza Shafia Naz, Rehana Dilshad, Mohtmam Nazir, Anfal Hamza
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
