Open Bedside Surgical Tracheostomy: A Retrospective Study of Outcomes and Advantages

Objective: Surgical tracheostomy can be performed either at the bedside in the ICU (OBST) or in the operating room (ORST). OBST represents an attractive yet underused alternative to ORST, especially for critically ill patients, because it optimizes transport risks, healthcare resources, and costs. This study aimed to compare clinical outcomes and costs between OBST and ORST. Methods: Retrospective analysis was conducted at our Institution for adult patients who underwent OBST or ORST between 2014 and 2024. Clinical and surgical data were collected and procedural complications were graded according to the Clavien-Dindo (CD) system. Results: Out of 420 patients, 199 (47.4%) underwent OBST and 221 (52.6%) ORST. OBST patients had higher BMI (p = 0.004) and lower age-adjusted Charlson comorbidity index (CCI) (p = 0.001). There were no significant differences between the two groups in terms of operative time, surgeon's experience, and rates of intraoperative or postoperative complications. Multivariate analysis for CD ≥ 3 postoperative complications showed previous tracheostomy to be a significant predictor (p = 0.017) while the setting was not (p = 0.497). Unfavorable neck anatomy was the only independent predictive factor for intraoperative complications (p = 0.045). Bjork flap was found to be protective against all complications (p = 0.008). Additionally, OBST was associated with a 53.6% cost reduction. Conclusion: OBST and ORST demonstrated comparable intra- and postoperative safety. In particular, OBST was not an independent risk factor for major complications and therefore it should be considered the first choice wherever surgical tracheostomy is required. Level of Evidence: 3.