A 54-year-old female with HTN, IDDM, obesity, and postintubation tracheal stenosis underwent a 4.3 cm tracheal resection with a pedicle flap. She is extubated after the surgery and maintained with head elevation, neck flexion, voice rest, and NPO. Routine bronchoscopy reveals a small anterior separation at the anastomosis site.
Which of the following is not a risk factor for tracheal anastomosis complications?A. Age less than 18
Correct Answer: C
The most frequent indication for tracheal resection is postintubation tracheal stenosis. Other indications include tumor, idiopathic laryngotracheal stenosis, and tracheoesophageal fistula. Operative complications can be divided into anastomotic (granulation tissue, restenosis, and separation) and nonanastomotic (infection, laryngeal dysfunction, edema, post-op hoarseness, and fistula). Based on the largest case series published on postoperative outcomes from Massachusetts General Hospital from 1975 to 2003, anastomotic complications occurred in 9% of patients, with separation occurring in 4% of patients. Risk factors for anastomotic complications were identified as reoperation, diabetes, tracheal resection ≥4 cm, laryngotracheal resection, and age <18. Interestingly, neither obesity (BMI >35) or steroid use was a risk factor. The most important postoperative goal is to minimize anastomotic tension. That is accomplished by early extubation (if possible), neck flexion, minimizing coughing and vomiting, voice rest, careful swallow evaluation, and routine bronchoscopy to detect issues before occurrence of symptoms. Careful attention should be paid toward stridor, voice changes, secretions, subcutaneous air, and neck swelling. Should timely extubation be difficult, a small tracheostomy at least 2 cm distal to the anastomosis should be considered.