Haemorrhagic complications tracheotomy in the era of COVID-19 – a retrospective study

Introduction: New type of coronavirus SARS-CoV-2 (COVID-19) infection usually manifests as an upper respiratory tract infection. Some patients develop pneumonia, which can progress into serious respiratory insuffi ciency with the need of artifi cial pulmonary ventilation (APV). In case of a long-term APV, it is necessary to perform tracheotomy. Since COVID-19 infection causes thrombophilia and patients are treated with anticoagulants, these patients might be in greater risk of postoperative complications, mainly bleeding, after tracheotomy. Aims: To assess the frequency of severe postoperative bleeding after tracheotomy in COVID-19 positive patients with prolonged orotracheal intubation and to identify risk factors of severe bleeding in patients after tracheotomy. Materials and methodology: A retrospective analysis of patients with tracheostomy due to prolonged APV was performed between 2020– 2022. The data were obtained from the hospital information system and were statistically analyzed. Results: Out of a total of 146 patients, bleeding requiring surgical revision in the intensive care unit or in the operating room occurred in 30 (20.5%) patients. Among these patients, a COVID-19 PCR test was positive in 20/ 30 (66.7%) and negative in 10/ 30 (33.3%) patients. From all of the analyzed factors, the only factor with statistical signifi cance was a therapeutical dose of anticoagulants (P = 0.012). Ocurrence of bleeding was not infl uenced by the type of surgery, transsection of the thyroid gland isthmus, setting of the surgery, or qualifi cation of the surgeon. Conclusion: Results of this retrospective study did not show a higher risk of bleeding after tracheotomy in COVID-19 positive patients compared to COVID-19 negative patients. However, the multiple logistic regression model suggested that COVID-19 infection could increase the risk. Therapeutical anticoagulant treatment is a clear risk factor of severe postoperative bleeding after tracheotomy. Key words tracheotomy – COVID-19 pneumonia – hemorrhagic complications – complications of tracheotomy