<scp>CT</scp> ‐Based Comparison of Tracheostomy Placement Accuracy: Open Versus Percutaneous Approaches

ABSTRACT Objective To evaluate stoma placement accuracy using computed tomography (CT) in patients undergoing open surgical (OST) versus percutaneous dilational (PDT) tracheostomy, and identify factors associated with high placement. Methods We retrospectively reviewed adults who underwent OST or PDT at a tertiary center (July 2012–July 2024) with CT imaging ≤ 30 days post‐procedure. The primary outcome was vertical distance from the inferior cricoid border to cannula center (mm). Placement was classified as high (≤ 10 mm) or non‐high (&gt; 10 mm). Multivariate regression identified predictors. Subgroup analysis was performed for otolaryngology cases. Results Of 503 patients (mean age 59.5 ± 18 years, 69.2% male), 421 (83.7%) underwent PDT and 82 (16.3%) OST. Mean distance was 12.6 ± 9.3 mm, shorter in PDT than OST (mean difference −2.4 mm; 95% CI: −4.6 to −0.2; p = 0.03), with no difference in high placement rates (37.1% vs. 31.7%; p = 0.36). Independent predictors of shorter distance were older age, higher BMI, general surgery team, and larger cannula diameter. Female gender was associated with greater distance. Predictors of high placement included older age, higher BMI, and larger cannula diameter. In the otolaryngology‐only subgroup ( n = 189), no differences in distance (mean difference 1.6 mm; 95% CI: −0.9 to 4.2; p = 0.22) or high placement rates were observed between groups; BMI was not associated with placement. Conclusions Technique alone did not determine high placement; patient factors, team, and cannula size were more influential. When performed by otolaryngologists, PDT achieves placement comparable to OST. Level of Evidence 3.