Abstract

Dr. Peter Appiah-Thompson*

ABSTRACT

Background: Tracheostomy has been an old life saving procedure. It may be done as an elective or emergency procedure depending on the indication. Objectives: a) To determine the frequency and indications of tracheostomy as well as reasons for late presentation of patients who require emergency tracheostomy at the Ear, Nose and Throat (ENT) Unit, Korle Bu Teaching Hospital, Accra. b) To determine whether there is a statistically significant difference in the outcome between changing the tracheostomy tube for the first time on the 3rd postoperative day and on the 5th postoperative day. Methods: This was a prospective cross-sectional study of patients who had tracheostomy at the ENT Unit, Korle Bu Teaching Hospital, Accra from 1st June, 2013 to 30th November, 2013. Hospital records were used to obtain indications for tracheostomy and establish frequency of tracheostomy over the period. Questionnaires were also administered to all patients who had tracheostomy from 1st June, 2013 to 30th November, 2013 and consented to be part of this study. Randomization of the patients into those for first tracheostomy tube change on the 3rd and 5th postoperative days were done. Results: The main indication for tracheostomy was found to be Acute Upper Airway Obstruction secondary to Laryngeal and Hypopharyngeal Tumours. This represented 68.0% of respondents. The frequency of tracheostomy done at the ENT Unit, Korle Bu Teaching Hospital was found to be 50 tracheostomies per year. 68.0% of the patients who had tracheostomy during the study period presented late to the ENT Unit, Korle Bu Teaching Hospital. The main reasons why these patients presented late was due to delayed referral by doctors and nurses and financial difficulties. Most of the patients who presented late were first seen at private and public hospitals. They represented 40.0% of respondents. 80.0% (20) of the patients who took part in the study had emergency tracheostomy whilst 20.0% (5) had elective tracheostomy. No statistically significant difference in terms of outcome was found between changing the tracheostomy tube for the first time on the 3rd postoperative day and on the 5th postoperative day (p-value was 0.672). Conclusions: The main indication for tracheostomy at the ENT Unit, Korle Bu Teaching Hospital is acute upper airway obstruction secondary to laryngeal tumour. The frequency of tracheostomy at the ENT Unit, Korle Bu Teaching Hospital is 50 tracheostomies per year. The main reason why patients who had tracheostomy presented late was due to doctors‘ and nurses‘ late referral. Changing the tracheostomy tube for the first time on the 3rd postoperative day is safe and thus this can be practiced. Patients can also be discharged home earlier with lower hospital bills.