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Safety of surgical tracheostomy under continued antithrombotic therapy
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  • Takayuki Sugaya,
  • Rumi Ueha,
  • Taku Sato,
  • Takao Goto,
  • Akihito Yamauchi,
  • Tatsuya Yamasoba
Takayuki Sugaya
The University of Tokyo
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Rumi Ueha
The University of Tokyo
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Taku Sato
The University of Tokyo
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Takao Goto
The University of Tokyo
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Akihito Yamauchi
The University of Tokyo
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Tatsuya Yamasoba
The University of Tokyo
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Abstract

Abstract Objective: Although various guidelines have been established for the management of antithrombotic therapy during surgical treatments, surgical tracheostomy (ST) under continued antithrombotic therapy (CAT) remains a challenge. We investigated the risk factors for complications after ST by focusing on CAT use during ST. Method: Patients’ medical records from 2009 to 2020 were reviewed in this retrospective study. We selected patients who underwent ST at the Department of Otolaryngology of the University of Tokyo Hospital. Patient demographics, complications, and blood test values were recorded and statistically analyzed to identify the risk factors for postoperative complications. Results: We identified 288 patients (median age: 64 years; 184 men [64%]), among whom 40 (median age: 67 years; 29 men [73%]) underwent CAT. Although the patients undergoing CAT had significantly higher values of activated partial thromboplastin time (p = 0.002) and prothrombin time-international normalized ratio (p = 0.006) than those of antithrombotic naïve patients, no statistically significant intergroup differences were observed in the risks of bleeding, infection, or subcutaneous emphysema. Instead, ST under local anesthesia (p = 0.01) and ST for airway emergency (p = 0.02) significantly increased the risk of early postoperative complications. Conclusion: The results of the present study suggest that ST under CAT can be safely performed without any increased risk of postoperative complications. Nevertheless, surgeons should be extra cautious about early complications after ST under local anesthesia without intubation or ST for airway emergency. Key points: 1. We aimed to investigate the risk factors for complications after ST by focusing on CAT use during ST. 2. Patients undergoing CAT had significantly higher values of APTT and PT-INR than those of antithrombotic naïve patients. 3. ST under CAT can be safely performed without any increased risk of postoperative complications. 4. ST under local anesthesia and airway emergency was a risk factor for complications after ST. 5. Among the complications, subcutaneous emphysema was significantly more frequent in ST under local anesthesia and under airway emergency.

Peer review status:ACCEPTED

24 May 2021Submitted to Clinical Otolaryngology
31 May 2021Assigned to Editor
31 May 2021Submission Checks Completed
27 Jun 20211st Revision Received
28 Jun 2021Submission Checks Completed
28 Jun 2021Assigned to Editor
17 Jul 2021Reviewer(s) Assigned
26 Aug 2021Review(s) Completed, Editorial Evaluation Pending
05 Sep 2021Editorial Decision: Accept