Avoiding prophylactic tracheostomies in head and neck surgeries with reconstructive free flaps: An institutional shift in practice
Research article published in Oral oncology (2026)
Abstract
BACKGROUND: In 2018, an initiative at the authors' institution aimed at reducing routine prophylactic tracheostomies for head and neck reconstructions with free flaps was implemented. Discussion between the surgical team and anesthesia about if a tracheostomy should be performed became the standard of care. The safety of this selective approach is assessed. METHODS: Retrospective review of patients ≥18-years who underwent a free flap for oral or oropharyngeal primaries from 2015 to 2021 at a single centre. Statistical analysis included subgroup analysis of patients pre-vs. post-2018. RESULTS: A total of 411 patients were included. Prophylactic tracheostomy rates decreased from 92.6% to 42.7% pre-2018 to post-2018. There was no significant difference in airway compromise or flap failure rates with non-tracheostomy. Post-2018, variables associated with tracheostomies included oropharynx primaries, advanced clinical nodal disease, and bilateral neck dissection (p < 0.05). On multivariate regression, surgical time (OR 1.182, p < 0.001), anesthetic time (OR 1.165, p < 0.001) and advanced clinical nodes (OR 1.304, p < 0.05) had increased odds of tracheostomy post-2018, while scapula vs. radial forearm free flaps had decreased odds (OR 0.717, p < 0.05). Patients with tracheostomies had longer hospital stays and more observed post-operative complications (p < 0.05). CONCLUSION: Prophylactic tracheostomies can be safely avoided in select patients undergoing oral and oropharyngeal free flaps, with no difference in airway or flap failure complications. These findings support multidisciplinary discussion between surgical and anesthetic teams regarding the indications for tracheostomies in head and neck cases. Further prospective studies are needed to identify exact criteria for tracheostomies in head and neck reconstructions with free flaps.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This single-centre retrospective review (411 patients, 2015-2021) examined whether prophylactic tracheostomy can be safely avoided in head-and-neck free-flap reconstruction after a 2018 practice change; prophylactic tracheostomy rates fell from 92.6% to 42.7%, with no significant difference in airway compromise or flap-failure rates, and tracheostomy patients had longer stays and more complications. For hirudotherapy the link is indirect and contextual: it concerns airway/peri-operative management of the same free-flap reconstructions for which leech therapy is an established adjunct against venous congestion, but the study itself is about tracheostomy decision-making, not flap salvage or the leech secretome. Caveat: this is a retrospective, single-institution cohort whose authors call for prospective studies to define exact criteria; it makes no mention of leech therapy and should not be read as evidence for or against it.
Citation
Avoiding prophylactic tracheostomies in head and neck surgeries with reconstructive free flaps: An institutional shift in practice.
Liu et al. · Oral oncology, 2026
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