• James T Brookes, Hadi Seikaly, Chris Diamond, Bradford Mechor, and Jeffrey R Harris.
• Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta.
• J Otolaryngol. 2006 Apr 1; 35 (2): 77-82.

PurposeThis study was designed to evaluate the effect of tracheostomy site suturing after decannulation on swallowing rehabilitation, the incidence of postoperative complications, the length of hospital stay, and overall cost saving in patients undergoing major head and neck cancer resections.DesignProspective, randomized, blinded, controlled clinical trial.MethodsSeventy-five patients undergoing major head and neck cancer resections were block randomized to have their tracheostomy site sutured or not sutured at the time of decannulation. Two blinded speech-language pathologists conducted bedside swallowing assessments immediately after decannulation. Patients resumed oral feedings if they passed; otherwise, the assessment was repeated daily until they were able to resume oral feedings or required a G-tube.Outcome MeasuresWe monitored (1) time intervals during the admission from surgery to discharge, (2) the rate of aspiration, (3) complications, and (4) cost savings.ResultsSignificant differences were seen in the mean time from decannulation and commencement of swallowing (suture arm, 0.58 days; nonsuture arm, 2.7 days; p = .013). There was also a significant difference seen for the time interval from decannulation to discharge from hospital (suture arm, 5.5 days; nonsuture arm, 8.3 days; p = .045) and for overall duration of hospital stay (suture arm, 14.6 days; nonsuture arm, 19.3 days; p = .025). The cost saving per patient in the suture group averaged $11 609, which translates to a yearly saving of 742 976 dollars.ConclusionThe suturing of the tracheostomy site in head and neck cancer patients after decannulation is a safe, effective, cost-saving manoeuvre that speeds the return of the patient's normal swallowing, promoting earlier discharge from the hospital.

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