Meta‐Analysis Comparison of Open Versus Percutaneous Tracheostomy

OBJECTIVES/HYPOTHESIS: Multiple studies have been performed to characterize differences in complications and cost-effectiveness of open and percutaneous tracheostomy; however, large enough studies have not been performed to determine a clearly superior method. Our primary objective was to compare complication rates of open versus percutaneous tracheostomy in prospective, randomized-controlled trials using meta-analysis methodology. Secondary objectives included cost-effectiveness and procedure length analyses. STUDY DESIGN: Meta-analysis. METHODS: From 368 abstracts, 15 prospective, randomized-controlled trials involving nearly 1, 000 patients were reviewed to extract basic demographic data in addition to complications, case length, and cost-effectiveness. Pooled odds ratios (OR) with confidence intervals (CI) were calculated in addition to subgroup analyses and meta-regression. RESULTS: Pooled OR revealed statistically significant results against percutaneous tracheostomy for the complication of decannulation/obstruction (OR 2. 79, 95% CI 1. 29-6. 03). There were significantly fewer complications in the percutaneous group with respect to wound infection (0. 37, 0. 22-0. 62) and unfavorable scarring (0. 44, 0. 23-0. 83). There was no statistically significant difference for complications of false passage (2. 70, 0. 89-8. 22), minor hemorrhage (1. 09, 0. 61-1. 97, P =. 77), major hemorrhage (0. 60, 0. 28-1. 26), subglottic stenosis (0. 59, 0. 27-1. 29), death (0. 70, 0. 24-2. 01), and overall complications (0. 75, 0. 56-1. 00). However, the overall complications trended toward favoring the percutaneous technique. Percutaneous tracheostomy case length was shorter overall by 4. 6 minutes, and costs were less by approximately 456 USD. CONCLUSIONS: Our meta-analysis illustrates there is no clear difference but a trend toward fewer complications in percutaneous techniques. Percutaneous tracheotomies are more cost-effective and provide greater feasibility in terms of bedside capability and nonsurgical operation.