Long-Term Outcomes of Patients Undergoing Cricothyrotomy at a Tertiary Care Level One Trauma Center.

Abstract

To identify short-term and long-term outcomes and complications for patients who underwent cricothyrotomy. A retrospective review was conducted for all patients who underwent cricothyrotomy between 2014 and 2025. Data included demographics, procedural details such as time to tracheostomy conversion and success rates, hospital course, short-term complications (e.g., dysphagia, pneumonia, vocal cord paralysis), and long-term complications (e.g., subglottic stenosis, vocal fold injury). Forty-eight patients underwent emergent cricothyrotomy. 72.9% were male and the mean age was 57.7 years. Common short-term complications included dysphagia (35.4%), pneumonia (31.3%), and dysphonia (27.1%). Planned conversion to tracheostomy occurred in 83.3% of patients, on average 2.3 days post-cricothyrotomy. Time to tracheostomy was significantly longer in patients who developed pneumonia (3.9 vs. 1.4 days, p = 0.005). In-hospital mortality was 20.8% and 90-day mortality was 29.2%. The mean post-cricothyrotomy hospital length of stay was 19.4 days. Long-term complications included persistent dysphagia (18.8%), subglottic stenosis (12.5%), and vocal fold injury (10.4%). Thirty-day return to the ED visits occurred in 20.8% of patients, with both airway and comorbidity-related presentations. Twenty patients (41.7%) ultimately had their tracheostomy tube removed with a mean time to decannulation of 83.7 days. Cricothyrotomy remains a vital, life-saving intervention in the difficult airway algorithm but carries a risk of significant post-procedural complications, including dysphagia, pneumonia, dysphonia, subglottic stenosis, and vocal fold injury. These findings highlight the importance of meticulous postoperative care, particularly respiratory management, to reduce delays in conversion to tracheostomy and optimize long-term outcomes.