Meta‐Analysis Comparison of Open Versus Percutaneous Tracheostomy

Abstract 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.