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J Thorac Cardiovasc Surg 2004;128:731-739
© 2004 The American Association for Thoracic Surgery

General thoracic surgery

Anastomotic complications after tracheal resection: Prognostic factors and management

Division of General Thoracic Surgery, Massachusetts, General Hospital, Boston, Mass

Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25-28, 2004.

Received for publication February 27, 2004; revisions received June 23, 2004; accepted for publication July 2, 2004.

^* Address for reprints: Cameron D. Wright, MD, Blake 1570, Massachusetts General Hospital, Boston, MA 02114 (E-mail: Wright.Cameron{at}mgh.harvard.edu).

OBJECTIVE: We sought to identify risk factors for anastomotic complications after tracheal resection and to describe the management of these patients.

METHODS: This was a single-institution, retrospective review of 901 patients who underwent tracheal resection.

RESULTS: The indications for tracheal resection were postintubation tracheal stenosis in 589 patients, tumor in 208, idiopathic laryngotracheal stenosis in 83, and tracheoesophageal fistula in 21. Anastomotic complications occurred in 81 patients (9%). Eleven patients (1%) died after operation, 6 of anastomotic complications and 5 of other causes (odds ratio 13.0, P= .0001 for risk of death after anastomotic complication). At the end of treatment, 853 patients (95%) had a good result, whereas 37 patients (4%) had an airway maintained by tracheostomy or T-tube. The treatments of patients with an anastomotic complication were as follows: multiple dilations (n = 2), temporary tracheostomy (n = 7), temporary T-tube (n = 16), permanent tracheostomy (n = 14), permanent T-tube (n = 20), and reoperation (n = 16). Stepwise multivariable analysis revealed the following predictors of anastomotic complications: reoperation (odds ratio 3.03, 95% confidence interval 1.69-5.43, P= .002), diabetes (odds ratio 3.32, 95% confidence interval 1.76-6.26, P= .002), lengthy (4 cm) resections (odds ratio 2.01, 95% confidence interval 1.21-3.35, P= .007), laryngotracheal resection (odds ratio 1.80, 95% confidence interval 1.07-3.01, P= .03), age 17 years or younger (odds ratio 2.26, 95% confidence interval 1.09-4.68, P= .03), and need for tracheostomy before operation (odds ratio 1.79, 95% confidence interval 1.03-3.14, P= .04).

CONCLUSIONS: Tracheal resection is usually successful and has a low mortality. Anastomotic complications are uncommon, and important risk factors are reoperation, diabetes, lengthy resections, laryngotracheal resections, young age (pediatric patients), and the need for tracheostomy before operation.

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