Tracheostomy with thyroidectomy: indications, management and outcome: a prospective study.

Objectives: This study aims to determine the indications, course and outcome of pre-operative and post-thyroidectomy tracheostomy.

Subjects And Methods: This is a prospective descriptive study conducted in Khartoum Teaching Hospital in the period between March 2000 and March 2005. Fifty-nine patients had tracheostomy out of 964 thyroidectomy patients, giving an incidence of 6%.

Results: The decision of doing tracheostomy was taken intra-operatively in 41 patients (69%), all presenting with strider. In 25 of those 41 patients there was intra-operative tracheal deformity with narrowing (>50% of tracheal circumference on radiology) and gland adherence to the tracheal wall; the remaining 16 patients had tracheomalacia. Of those 41 patients, 25 presented with severe strider and needed urgent surgery (5 with recurrent anaplastic carcinoma, 5 with intrathoracic goitres that necessitated median sternotomy and 15 with huge goitres (of whom 7 were recurrent goitres). In the remaining 18 patients (31%) emergency post-operative tracheostomy was done following endotracheal extubation up to 48 h post-operatively. There were 2 deaths (3.4%); one patient died due to tracheostomy care and the other from myocardial infarction.

Conclusion: Tracheostomy is a safe procedure and gives a good alternative to delayed endotracheal extubation in post-thyroidectomy patients expected to have respiratory failure in places where post-operative anaesthetic care is lacking.