Percutaneous or surgical tracheostomy: a meta-analysis

Crit Care Med. 1999 Aug;27(8):1617-25. doi: 10.1097/00003246-199908000-00041.


Objective: To compare percutaneous with surgical tracheostomy using a meta-analysis of studies published from 1960 to 1996.

Data sources: Publications obtained through a MEDLINE database search with a Boolean combination (tracheostomy or tracheotomy) and complications, with constraints for human studies and English language.

Study selection: Publications addressing all peri- and postoperative complications. Studies limited to specific tracheostomy complications or containing insufficient details were excluded. Two authors independently selected the publications.

Data extraction: A list of relevant surgical variables and complications was compiled. Complications were divided into peri- and postoperative groups and further subclassified into severe, intermediate, and minor groups. Because most studies of percutaneous tracheostomy were published after 1985, surgical tracheostomy studies were divided into two periods: 1960 to 1984 and 1985 to 1996. The articles were analyzed independently by three investigators, and rare discrepancies were resolved through discussion and data reexamination.

Data synthesis: Earlier surgical tracheostomy studies (n = 17; patients, 4185) have the highest rates of both peri- (8.5%) and postoperative (33%) complications. Comparison of recent surgical (n = 21; patients, 3512) and percutaneous (n = 27; patients, 1817) tracheostomy trials shows that perioperative complications are more frequent with the percutaneous technique (10% vs. 3%), whereas postoperative complications occur more often with surgical tracheotomy (10% vs. 7%). The bulk of the differences is in minor complications, except perioperative death (0.44% vs. 0.03%) and serious cardiorespiratory events (0.33% vs. 0.06%), which were higher with the percutaneous technique. Heterogeneity analysis of complication rates shows higher heterogeneity in older and surgical trials.

Conclusions: Percutaneous tracheostomy is associated with a higher prevalence of perioperative complications and, especially, perioperative deaths and cardiorespiratory arrests. Postoperative complication rates are higher with surgical tracheostomy.

Publication types

  • Comparative Study
  • Meta-Analysis

MeSH terms

  • Adult
  • Age Distribution
  • Child
  • Cross Infection / etiology
  • Heart Arrest / etiology
  • Hemorrhage / etiology
  • Humans
  • Mediastinal Emphysema / etiology
  • Middle Aged
  • Patient Selection
  • Pneumothorax / etiology
  • Research Design
  • Severity of Illness Index
  • Tracheoesophageal Fistula / etiology
  • Tracheostomy / adverse effects*
  • Tracheostomy / methods*
  • Tracheostomy / mortality
  • Tracheostomy / trends
  • Tracheotomy / adverse effects*
  • Tracheotomy / methods*
  • Tracheotomy / mortality
  • Tracheotomy / trends
  • Treatment Outcome