Is Tracheostomy Safe?: Common Indications and Early Complications Among Ugandan Patients In A Pre-Covid-19 Era.

Abstract

Background: Tracheostomy is a life-saving procedure whose outcomes may vary between hospitals based on disparities in their existing expertise. We aimed at establishing the indications, early tracheostomy-related complications and their associated factors in Uganda. Methods: In a prospective cohort study, we consecutively enrolled one-hundred patients, both adults and children 2 hours’ post-tracheostomy procedure. At baseline, information on patients’ socio-demographics, tracheostomy indications, pre- and post-procedural characteristics was collected through researcher administered questionnaires and from medical records. Clinical examination was performed at baseline but also at either day 7 or whenever a tracheostomy-related complication was suspected during the 7days follow-up. Comparison of patients’ baseline characteristics, tracheostomy indications and complications across two hospitals was done using Pearson’s chi-square. For predictors of early tracheostomy complications, bivariate and multivariate analysis models were fitted using binomial regression in STATA 13.0 software. Results: Majority of patients were adults (84%) and males (70%). The commonest tracheostomy indications were; pulmonary toilet (58%) and anticipated prolonged intubation (42%). Overall, 53% (95% CI: 43.0 – 62.7) had early complications with the commonest being tube obstruction (52.6%). Independent predictors of early tracheostomy-related complications were; anticipated having prolonged intubation as an indication (RR=1.8, 95%CI: 1.19 – 2.76), Bjork flap tracheal incision (RR=1.6, 95%CI: 1.09 – 2.43), vertical tracheal incision (RR=1.53, 95%CI: 1.02 – 2.27), and age below 18 years (RR=1.22, 95%CI: 1.00 – 1.47). Conclusion: Within a pre-COVID-19 context, pulmonary toilet is the commonest tracheostomy indication at major hospitals in Uganda. The incidence of early tracheostomy complications is high and majorly related to post-procedure tracheostomy tube management. Having anticipated prolonged intubation as an indication for tracheostomy, a Bjork flap or vertical tracheal incisions and being a child increases the risk of complications. Emphasis on surgical training and post-procedural management for both clinicians and nurses should be made. New data will be needed within the COVID-19 era.