Percutaneous vs. surgical tracheostomy in the intensive care unit: clinical outcomes, complications, and hospital stay: a single retrospective observational study

Tracheostomy tube (TT) procedures are common surgical interventions performed in operating rooms, intensive care units (ICUs), or emergency departments. In ICUs, TT insertion is primarily indicated for patients requiring long-term mechanical ventilation. In recent years, percutaneous bedside tracheostomy (PDT) has increasingly replaced the traditional surgical tracheostomy (ST) at many institutions. However, current literature still lacks robust evidence to guide the selection between PDT and ST in ICU settings. This single-center observational study aimed to compare the clinical outcomes of PDT and ST among ICU patients, focusing on indications, complications, and hospital stay. Adult ICU patients who underwent tracheostomy at King Abdullah Medical City were included. Data extracted included demographics, APACHE II score, BMI, duration of intubation, tracheostomy indications, complications, and tracheostomy tube characteristics. Patients with prior tracheostomy or pre-ICU procedures were excluded. PDT was performed by ICU physicians and ST by otolaryngologists (IRB approval: KAMC 25–1421). Data was assessed using SPSS software. A total of 316 patients were analyzed; 185 (58.5%) underwent PDT and 131 (41.5%) received ST. The main indication was prolonged mechanical ventilation (53%), followed by failed extubation (28.7%) and neurological disorders (7.6%). Overall, 90.6% of patients had no complications; bleeding (6.9%) was most frequent. PDT was associated with fewer complications and significantly shorter ICU and ward stays (p < 0.001). Patients with fenestrated, cuffed TT types had shorter ICU stays compared to non-fenestrated, cuffless tubes. Multivariable regression analysis showed that age and tracheostomy indications were significant predictors of length of stay. Both techniques were safe, but PDT proved superior as a bedside procedure, showing fewer complications and shorter hospital stays, enhancing patient recovery and ICU efficiency.