Tracheostomy Experience among Indian Otolaryngology-Head and Neck Surgery Residents – A Survey

Background: Tracheostomy is a common surgical procedure which otolaryngology-head and neck surgery (ORL-HNS) trainees are expected to perform in both emergency and elective settings. Few papers deal specifically with resident training in this procedure. we surveyed the standard of training in the Indian context. Materials and Methods: A questionnaire-based survey was conducted among residents attending the annual national conference of the Association of Otolaryngologists of India. The results of the survey were tabulated using Microsoft Excel. Results: Ninety questionnaires were circulated among postgraduate trainees in their 1st, 2nd, or 3rd year of training (P-1, P-2, and P-3) as well as senior residents (SR). The response rate was 47%. The majority of the respondents (51%) were P-2. The distribution between elective and emergency tracheostomy was variable. The most common indication for tracheostomy in our survey was prolonged Intensive Therapy Unit (ITU) ventilation (42%). In elective tracheostomy, the primary surgeon was either an SR or P-3 (60%) and used a horizontal incision (52%). In emergencies, the primary surgeon was either an SR or P-3 and preferred a vertical incision (65%). Most trainees exposed the trachea by layer dissection; only 6% used monopolar diathermy. Entry through vertical incision and dilator was the preferred method (51%). The first tube change was performed at 72 h by 49% of the respondents. Eighty-four percent of the trainees were confident of performing emergency tracheostomies independently. Conclusions: ORL-HNS trainees should be competent in tracheostomy. The lack of supervision by faculty, variation in steps, and postoperative management all impact the outcome. A standardized technique and faculty supervision are vital for optimum training.