Non-Cochrane · prognostic · PM41273066
Tracheostomy in Flap-Based Head and Neck Cancer Surgery: A Meta-Analysis of Indications and Adverse Outcomes.
Chowdhury Raisa, Tran Khanh Linh, Karimi Naser, et al. · Head & neck · 2026 · PubMed · doi:10.1002/hed.70102
Findings
18 findings
| Population | ||||
|---|---|---|---|---|
| Adults who had a tracheostomy during flap-based head and neck cancer surgery | Tracheostomy | None | Other infections (surgical site infection, septic shock, stomal infection, infected dehiscence, wound dehiscence) | Pooled proportion (%) 7.8 [3.0, 14.3] GRADE not reported 5 studies · 1748 participants |
| Adults who had a tracheostomy during flap-based head and neck cancer surgery | Tracheostomy | None | Bleeding (supplementary forest plot: Cai 2020, Madgar 2022, Malata 1996) | Pooled proportion (%) 2.9 [1.5, 4.7] GRADE not reported 3 studies · 478 participants |
| Adults who had a tracheostomy during flap-based head and neck cancer surgery | Tracheostomy | None | Obstructed tracheostomy tube (supplementary forest plot: Castling 1994, Halfpenny 2000) | Pooled proportion (%) 2.7 [1.0, 4.9] GRADE not reported 2 studies · 316 participants |
| Adults who had a tracheostomy during flap-based head and neck cancer surgery | Tracheostomy | None | Chest infections | Pooled proportion (%) 7.7 [4.4, 11.6] GRADE not reported 6 studies · 1115 participants |
| Adults who had a tracheostomy during flap-based head and neck cancer surgery | Tracheostomy | None | Accidental dislodgement (supplementary forest plot: Cai 2020, Castling 1994, Halfpenny 2000) | Pooled proportion (%) 1.1 [0.2, 2.5] GRADE not reported 3 studies · 638 participants |
| Adults undergoing free or pedicled flap reconstruction in head and neck cancer surgery | Tracheostomy during flap-based head and neck surgery | None (pooled proportion) | Temporal trend in tracheostomy rate Head and neck cancer flap-based surgery | Linear regression slope 0.121 GRADE not reported Studies not reported |
| Adults who had a tracheostomy during flap-based head and neck cancer surgery | Tracheostomy | None | Infections (supplementary forest plot: Leiser 2016 infected dehiscence, Madgar 2022 stomal infection) | Pooled proportion (%) 8.9 [0.0, 37.5] GRADE not reported 2 studies · 88 participants |
| Adults who had a tracheostomy during flap-based head and neck cancer surgery | Tracheostomy | None | Overall complication rate | Pooled proportion (%) 16.3 [6.9, 28.5] GRADE not reported 6 studies · 825 participants |
| Adults who had a tracheostomy during flap-based head and neck cancer surgery | Tracheostomy | None | Tracheal stenosis (supplementary forest plot: Madgar 2022 twice, Halfpenny 2000) Unresolved: the two extractors disagree on this row. | Pooled proportion (%) 1.1 [0.0, 3.7] GRADE not reported 2 studies · 378 participants |
| Adults undergoing flap-based head and neck cancer surgery | Tracheostomy | None | Overall tracheostomy rate | Pooled proportion (%) 54.6 [38.7, 70.0] GRADE not reported 26 studies · 27029 participants |
| Adults who had a tracheostomy during flap-based head and neck cancer surgery | Tracheostomy | None | Airway-related complications (tracheal stenosis, supra-stomal stenosis, surgical/subcutaneous emphysema) | Pooled proportion (%) 2.6 [0.5, 5.7] GRADE not reported 5 studies · 1098 participants |
| Adults undergoing flap-based head and neck cancer surgery | Tracheostomy | None | Overall tracheostomy rate, sensitivity analysis excluding studies with 100% tracheostomy | Pooled proportion (%) 42.4 [29.6, 55.8] GRADE not reported 22 studies · 26753 participants |
| Adults who had a tracheostomy during flap-based head and neck cancer surgery | Tracheostomy | None | Tube-related complications (accidental dislodgement, obstructed tube, displaced tube) | Pooled proportion (%) 1.2 [0.2, 2.6] GRADE not reported 5 studies · 614 participants |
| Adults who had a tracheostomy during flap-based head and neck cancer surgery | Tracheostomy | None | Bleeding (text estimate) | Pooled proportion (%) 8.1 [0.0, 25.9] GRADE not reported Studies not reported |
| Adults undergoing flap-based head and neck cancer surgery | Advanced tumor stage (T3-T4) | Early tumor stage (T1-T2) | Tracheostomy | OR 3.85 [1.40, 10.61] GRADE not reported 4 studies · 17771 participants |
| Adults undergoing flap-based head and neck cancer surgery | Oropharyngeal tumor site | Oral cavity tumor site | Tracheostomy | OR 2.30 [1.10, 4.79] GRADE not reported 3 studies · 1458 participants |
| Adults undergoing flap-based head and neck cancer surgery | Bilateral neck dissection | Unilateral neck dissection | Tracheostomy | OR 9.36 [4.94, 17.74] GRADE not reported 3 studies · 546 participants |
| Adults undergoing free or pedicled flap reconstruction in head and neck cancer surgery | Free flap reconstruction | Pedicled flap reconstruction | Tracheostomy Head and neck cancer flap-based surgery | OR 1.95 [0.57, 6.68] GRADE not reported 3 studies · 262 participants |
Included primary studies 50
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Abdelrahman 2023 Percutaneous tracheostomy in head and neck oncology surgery: How Covid-19 changed our practice DOI:10.1016/j.adoms.2023.100422 | 2023 | this review only | Overall tracheostomy rate | not extracted yet |
| Adhikari 2023 Comparison of postoperative complications in early versus delayed tracheostomy decannulation in patients undergoing oral cancer surgery… DOI:10.1016/j.bjoms.2022.11.285 | 2023 | this review only | Overall tracheostomy rate | not extracted yet |
| Adhikari 2023 Comparison of postoperative complications in early versus delayed tracheostomy decannulation in patients undergoing oral cancer surgery… PMID:36586735 | 2023 | this review only | Overall tracheostomy rate | not extracted yet |
| Cai 2020 Scoring system for selective tracheostomy in head and neck surgery with free flap reconstruction DOI:10.1002/hed.26028 | 2019 | this review only | Overall tracheostomy rate; Tracheostomy; PM41273066-P6-O6; PM41273066-P6-O8 | not extracted yet |
| Cai 2020 Scoring system for selective tracheostomy in head and neck surgery with free flap reconstruction. PMID:31799777 | 2020 | this review only | Overall tracheostomy rate | not extracted yet |
| Castling 1994 Complications of tracheostomy in major head and neck cancer surgery; a retrospective study of 60 consecutive cases DOI:10.1016/0266-4356(94)90162-7 | 1994 | this review only | Overall tracheostomy rate; PM41273066-P6-O8; PM41273066-P6-O9 | not extracted yet |
| Castling 1994 Complications of tracheostomy in major head and neck cancer surgery; a retrospective study of 60 consecutive cases. PMID:8136336 | 1994 | this review only | Overall tracheostomy rate | not extracted yet |
| Chen 2017 Free flap reconstruction for patients aged 85 years and over with head and neck cancer: clinical considerations for comprehensive care DOI:10.1016/j.bjoms.2017.07.003 | 2017 | this review only | Overall tracheostomy rate | not extracted yet |
| Chen 2017 Free flap reconstruction for patients aged 85 years and over with head and neck cancer: clinical considerations for comprehensive care. PMID:28735639 | 2017 | this review only | Overall tracheostomy rate | not extracted yet |
| Cramer 2016 Association of Airway Complications With Free Tissue Transfer to the Upper Aerodigestive Tract With or Without Tracheotomy DOI:10.1001/jamaoto.2016.2002 | 2016 | this review only | Overall tracheostomy rate; Tracheostomy | not extracted yet |
| Cramer 2016 Association of Airway Complications With Free Tissue Transfer to the Upper Aerodigestive Tract With or Without Tracheotomy. PMID:27438584 | 2016 | this review only | Overall tracheostomy rate | not extracted yet |
| Davis 2022 Postoperative and 1‐Year Functional Outcomes After Free Flap Surgery Among Patients 80 Years or Older DOI:10.1177/01945998221083592 | 2022 | this review only | Overall tracheostomy rate | not extracted yet |
| Davis 2022 Postoperative and 1-Year Functional Outcomes After Free Flap Surgery Among Patients 80 Years or Older. PMID:35290129 | 2022 | this review only | Overall tracheostomy rate | not extracted yet |
| Esteller 2014 Stomal recurrence in head and neck cancer patients with temporary tracheostomy DOI:10.1016/j.anl.2014.02.003 | 2014 | this review only | Overall tracheostomy rate | not extracted yet |
| Esteller 2014 Stomal recurrence in head and neck cancer patients with temporary tracheostomy. PMID:24602695 | 2014 | this review only | Overall tracheostomy rate | not extracted yet |
| Fang 2024 Prognostic impact of elective tracheotomy in resected oral cavity squamous cell carcinoma: A nationwide cohort study DOI:10.1002/cam4.7213 | 2024 | this review only | Overall tracheostomy rate; PM41273066-P2-O1 | not extracted yet |
| Fang 2024 Prognostic impact of elective tracheotomy in resected oral cavity squamous cell carcinoma: A nationwide cohort study. PMID:38888352 | 2024 | this review only | Overall tracheostomy rate | not extracted yet |
| Gupta 2016 Clinical assessment scoring system for tracheostomy (CASST) criterion: Objective criteria to predict pre-operatively the need for a… DOI:10.1016/j.jcms.2016.07.008 | 2016 | this review only | Overall tracheostomy rate | not extracted yet |
| Gupta 2016 Clinical assessment scoring system for tracheostomy (CASST) criterion: Objective criteria to predict pre-operatively the need for a… PMID:27499512 | 2016 | this review only | Overall tracheostomy rate | not extracted yet |
| Gupta 2024 Can Prophylactic Tracheostomy be Avoided in Advanced Oral Cancer Surgery for Airway Management? An Experience and Guidelines from a… DOI:10.1007/s12663-024-02237-x | 2024 | this review only | Overall tracheostomy rate | not extracted yet |
| Gupta 2024 Can Prophylactic Tracheostomy be Avoided in Advanced Oral Cancer Surgery for Airway Management? An Experience and Guidelines from a… PMID:39118921 | 2024 | this review only | Overall tracheostomy rate | not extracted yet |
| Halfpenny 2000 Analysis of tracheostomy-associated morbidity after operations for head and neck cancer DOI:10.1054/bjom.2000.0310 | 2000 | this review only | Overall tracheostomy rate; PM41273066-P6-O7; PM41273066-P6-O8; PM41273066-P6-O9 | not extracted yet |
| Halfpenny 2000 Analysis of tracheostomy-associated morbidity after operations for head and neck cancer. PMID:11010784 | 2000 | this review only | Overall tracheostomy rate | not extracted yet |
| Holcomb 2025 Tracheostomy Avoidance in Flap Reconstruction of the Upper Aerodigestive Tract is Safe in Selected Patients DOI:10.1002/ohn.963 | 2024 | this review only | Overall tracheostomy rate | not extracted yet |
| Holcomb 2025 Tracheostomy Avoidance in Flap Reconstruction of the Upper Aerodigestive Tract is Safe in Selected Patients. PMID:39210719 | 2025 | this review only | Overall tracheostomy rate | not extracted yet |
| Kim 2024 Efficacy of tracheostomy for respiratory management in patients with advanced oral cancer DOI:10.1186/s40902-024-00439-4 | 2024 | this review only | Overall tracheostomy rate; PM41273066-P2-O1 | not extracted yet |
| Kim 2024 Efficacy of tracheostomy for respiratory management in patients with advanced oral cancer. PMID:39037534 | 2024 | this review only | Overall tracheostomy rate | not extracted yet |
| Kruse-Losler 2005 Score system for elective tracheotomy in major head and neck tumour surgery DOI:10.1111/j.1399-6576.2005.00655.x | 2005 | this review only | Overall tracheostomy rate; Tracheostomy | not extracted yet |
| Kruse-Losler 2005 Score system for elective tracheotomy in major head and neck tumour surgery. PMID:15836679 | 2005 | this review only | Overall tracheostomy rate | not extracted yet |
| Lee 2022 Feasibility of Percutaneous Dilatational Tracheotomy in Head and Neck Cancer Surgery: A Preliminary Study DOI:10.9738/intsurg-d-21-00015.1 | 2022 | this review only | Overall tracheostomy rate | not extracted yet |
| Leiser 2016 Indications for Elective Tracheostomy in Reconstructive Surgery in Patients With Oral Cancer DOI:10.1097/scs.0000000000003168 | 2017 | this review only | Overall tracheostomy rate; Tracheostomy; PM41273066-P6-O3 | not extracted yet |
| Leiser 2016 Indications for Elective Tracheostomy in Reconstructive Surgery in Patients With Oral Cancer. PMID:27792099 | 2017 | this review only | Overall tracheostomy rate | not extracted yet |
| Madgar 2022 Airway management following head and neck microvascular reconstruction: is tracheostomy mandatory? DOI:10.1016/j.bjorl.2021.07.007 | 2022 | this review only | Overall tracheostomy rate; PM41273066-P6-O3; PM41273066-P6-O6; PM41273066-P6-O7 | not extracted yet |
| Madgar 2022 Airway management following head and neck microvascular reconstruction: is tracheostomy mandatory? PMID:34756557 | 2022 | this review only | Overall tracheostomy rate | not extracted yet |
| Malata 1996 An audit of Bjork flap tracheostomies in head and neck plastic surgery DOI:10.1016/s0266-4356(96)90134-5 | 1996 | this review only | Overall tracheostomy rate; PM41273066-P6-O6 | not extracted yet |
| Malata 1996 An audit of Björk flap tracheostomies in head and neck plastic surgery. PMID:8645682 | 1996 | this review only | Overall tracheostomy rate | not extracted yet |
| McDevitt 2016 Tracheostomy and infection prolong length of stay in hospital after surgery for head and neck cancer: a population based study DOI:10.1016/j.oooo.2015.08.004 | 2016 | this review only | Overall tracheostomy rate | not extracted yet |
| McDevitt 2016 Tracheostomy and infection prolong length of stay in hospital after surgery for head and neck cancer: a population based study. PMID:26455292 | 2016 | this review only | Overall tracheostomy rate | not extracted yet |
| Meier 2019 Influence of early elective tracheostomy on the incidence of postoperative complications in patients undergoing head and neck surgery DOI:10.1186/s12871-019-0715-9 | 2019 | this review only | Overall tracheostomy rate; PM41273066-P2-O1; Tracheostomy | not extracted yet |
| Meier 2019 Influence of early elective tracheostomy on the incidence of postoperative complications in patients undergoing head and neck surgery. PMID:30922231 | 2019 | this review only | Overall tracheostomy rate | not extracted yet |
| Mohamedbhai 2018 TRACHY score: a simple and effective guide to management of the airway in head and neck cancer DOI:10.1016/j.bjoms.2018.07.015 | 2018 | this review only | Overall tracheostomy rate; PM41273066-P2-O1; Tracheostomy | not extracted yet |
| Mohamedbhai 2018 TRACHY score: a simple and effective guide to management of the airway in head and neck cancer. PMID:30126752 | 2018 | this review only | Overall tracheostomy rate | not extracted yet |
| Nagarkar 2019 Airway management techniques in head and neck cancer surgeries: a retrospective analysis DOI:10.1007/s10006-019-00782-1 | 2019 | this review only | Overall tracheostomy rate | not extracted yet |
| Nagarkar 2019 Airway management techniques in head and neck cancer surgeries: a retrospective analysis. PMID:31172388 | 2019 | this review only | Overall tracheostomy rate | not extracted yet |
| Siddiqui 2016 Airway management and postoperative length of hospital stay in patients undergoing head and neck cancer surgery DOI:10.4103/0970-9185.173341 | 2016 | this review only | Overall tracheostomy rate | not extracted yet |
| Siddiqui 2016 Airway management and postoperative length of hospital stay in patients undergoing head and neck cancer surgery. PMID:27006541 | 2016 | this review only | Overall tracheostomy rate | not extracted yet |
| Tassone 2022 Factors Leading to Gastrostomy Tube and Tracheostomy Requirements in Patients Treated Initially With Radiotherapy and Salvaged With… DOI:10.1002/lary.30514 | 2022 | this review only | Overall tracheostomy rate | not extracted yet |
| Tassone 2022 Factors Leading to Gastrostomy Tube and Tracheostomy Requirements in Patients Treated Initially With Radiotherapy and Salvaged With… PMID:36478360 | 2023 | this review only | Overall tracheostomy rate | not extracted yet |
| Xu 2021 Predictive Nomogram for the Necessity of Tracheotomy During Oral and Oropharyngeal Cancer Surgery DOI:10.1002/lary.29121 | 2020 | this review only | Overall tracheostomy rate | not extracted yet |
| Xu 2021 Predictive Nomogram for the Necessity of Tracheotomy During Oral and Oropharyngeal Cancer Surgery. PMID:33016340 | 2021 | this review only | Overall tracheostomy rate | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (>=18 years) undergoing head and neck flap-based surgery (free and regional flaps) | Adults undergoing flap-based head and neck cancer surgery (n=27029 patients; 26 studies) |
| Intervention | Tracheostomy (predictive factors, airway management) | Tracheostomy; predictors tumor stage, tumor site, neck dissection, flap type, prior radiotherapy, smoking |
| Comparison | Not specified | T1-T2, oral cavity, unilateral neck dissection, pedicled flap |
| Outcomes | Predictive factors for tracheostomy (primary); tracheostomy rates, complication types and rates (secondary) | Tracheostomy rate; complications (overall, chest and other infections, tube-related, airway-related, bleeding); temporal trend |
| Study designs | Retrospective or prospective cohort, case-control, cross-sectional, longitudinal, case series, clinical trials | 26 observational studies (24 retrospective cohorts, 1 retrospective and prospective cohort, 1 observational study); no RCTs |
| Timing | Not specified | Publication years 1994 to 2025 |