Hybrid and Open Surgical Tracheostomy in a Single-Center Retrospective Cohort

Background/Objectives: Hybrid tracheostomy combines direct surgical exposure with guidewire dilation. We describe institutional procedure allocation and observed outcomes of hybrid and open surgical tracheostomy (ST). Methods: This single-center retrospective cohort included 294 procedures (243 hybrid and 51 open ST) performed from July 2020 to February 2022. Analyses included the existing 1:1 propensity-matched sample and descriptive stratification by recorded preoperative difficult-airway status. Results: The mean operative time was shorter with hybrid tracheostomy in the overall cohort (15.4 ± 8.9 vs. 24.8 ± 40.7 min, p = 0.001). After matching, the difference was not statistically significant (14.1 ± 7.0 vs. 29.0 ± 49.6 min, p = 0.092; independent-group Student’s t-test). Overall weaning success was 55.1%; no statistically significant between-group difference was observed after matching. In the exploratory difficult-airway subgroup, complications occurred after 1/29 hybrid procedures (3.4%) and 2/10 open ST procedures (20.0%). These small, selected subgroups do not establish a preferred technique. Conclusions: In this single-center retrospective study, hybrid tracheostomy appeared to be a safe and feasible option in selected patients. However, preoperative assessment for a difficult airway is essential to guide individualized procedural planning.