Tracheostomy in Flap-Based Head and Neck Cancer Surgery: A Meta-Analysis of Indications and Adverse Outcomes.

Abstract

Tracheostomy is frequently performed during flap-based reconstruction for head and neck cancer, but predictive factors and complications are not well established. A systematic review and meta-analysis was conducted per PRISMA guidelines. Studies of adult patients undergoing free or pedicled flap reconstruction were included. Pooled tracheostomy rates, predictors, and complications were analyzed using random-effects models. Heterogeneity was assessed with the I² statistic. Twenty-six studies (27 029 patients) were included. The pooled tracheostomy rate was 54.6%, decreasing to 42.4% when routine tracheostomy studies were excluded. Advanced tumor stage, oropharyngeal site, bilateral neck dissection, prior radiotherapy, and smoking predicted tracheostomy. Flap type was not significantly associated. The overall complication rate was 16.3%, including airway issues (2.6%). No significant change in tracheostomy rates was observed over 30 years. Tracheostomy use is influenced by tumor, surgical, and patient factors. Selective tracheostomy and validated risk tools may improve outcomes. Further prospective studies are needed.