Complication Rates Following Permanent Tracheostomy
Natalie Stilwell, DVM, MS, PhD
Dr. Natalie Stilwell provides freelance medical writing and aquatic veterinary consulting services through her business, Seastar Communications and Consulting. In addition to her DVM obtained from Auburn University, she holds a MS in fisheries and aquatic sciences and a PhD in veterinary medical sciences from the University of Florida.
Despite major postoperative complications, the authors of a recent study concluded that permanent tracheostomy placement in brachycephalic dogs with severe laryngeal collapse is a suitable salvage option.
Permanent tracheostomy is a surgical option for treatment of laryngeal collapse in canine patients. Until recently, existing literature lacked information detailing postoperative complication rates and survival data specifically in brachycephalic breeds.
In response, researchers in Europe recently performed a retrospective study examining long-term outcome of dogs that underwent permanent tracheostomy for brachycephalic airway obstructive syndrome (BAOS).
Researchers identified records of brachycephalic dogs undergoing permanent tracheostomy at 3 veterinary teaching hospitals in Europe between 2004 and 2015. Inclusion criteria included endoscopic diagnosis of severe laryngeal collapse and persistence of severe dyspnea despite surgical management of BAOS.
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Surgical procedures and perioperative care were similar among the 3 hospitals. Regular stoma maintenance included cleaning and mucus removal, nebulization with sterile saline solution, and superficial suctioning of the trachea. Owners were instructed to continue stoma maintenance at home.
Occurrence of postoperative complications, required revision surgeries, and survival data were obtained from records and telephone calls with owners. Owners were also questioned about their pets’ perceived quality of life after tracheostomy, as well as whether they considered stoma management to be simple or demanding.
Fifteen dogs were included in the study; breeds included pug, French bulldog, Chihuahua, Pekingese, and Cavalier King Charles spaniel. Presenting signs included severe respiratory distress (100%), cyanosis (73%), and collapsing episodes (40%). Thoracic radiography and upper respiratory endoscopy were performed for all dogs.
The most common treatments attempted before permanent tracheostomy were as follows: antibiotics and opioids (15 dogs), palatoplasty (11 dogs), rhinoplasty (7 dogs), laryngeal sacculectomy (5 dogs), and temporary tube tracheostomy (4 dogs). Six dogs underwent permanent tracheostomy within 15 days after another surgery, while 3 dogs had multiple revision surgeries before undergoing permanent tracheostomy.
Twelve of 15 dogs experienced major postoperative complications after permanent tracheostomy. Eight dogs died or were euthanized due to complications, while the majority of survivors required at least 1 revision surgery.
Postoperative complications included the following:
- Acute obstruction due to increased secretions or mucus plugs (7 dogs)
- Antibiotic-responsive airway secretions in the absence of stoma obstruction (4 dogs)
- Stoma obstruction due to redundant skin folds (3 dogs)
- Stoma stenosis (2 dogs)
- Wound dehiscence (2 dogs)
Median survival time (MST) after tracheostomy was 100 days for all dogs; however, MST was significantly lower for dogs that died from complications than for dogs that died from causes unrelated to tracheostomy and BAOS (15 vs 1982 days). One-third of dogs survived more than 5 years after surgery.
Seventy-three percent of owners said their pets had an improved quality of life after tracheostomy, while 27% considered quality of life to be similar before and after surgery. Most owners found stoma management to be undemanding.
Postoperative complications from permanent tracheostomy were fatal in approximately half of the study dogs, with most deaths occurring within 16 weeks after surgery. The authors noted that permanent tracheostomy should be considered a salvage procedure for those dogs that are unresponsive to other treatments.
Dr. Stilwell received her DVM from Auburn University, followed by a MS in fisheries and aquatic sciences and a PhD in veterinary medical sciences from the University of Florida. She provides freelance medical writing and aquatic veterinary consulting services through her business, Seastar Communications and Consulting.