Patients experience of temporary tracheostomy after microvascular reconstruction for cancer of the head and neck

A temporary tracheostomy (TT) is a commonly performed procedure as part of major reconstructive surgery following tumour ablation for advanced oral cancer. The tracheostomy provides easy access to a secure airway in case of haematoma or return to theatre. Although a relatively simple addition to the operation there is a lack of information on patients’ experience of a TT. The study involved three stages. Firstly semi-structured interviews to identify items related to functional, emotional and social impacts of the tracheostomy, on the ward and on removal. Secondly to use the items to develop a short one-page questionnaire in collaboration with the Patient and Carer Support Group and Research Forum. Thirdly a cross-sectional postal survey of patients having had a TT as part of free tissue reconstruction between January 2013 and July 2015. The general observation drawn from the interviews was that the TT was a negative experience, notably fears, specifically a fear of chocking and communication difficulties. In the cross-sectional survey a majority (60%) of responders stated that they would 'very much' avoid a tracheostomy if at all possible. The main problem was with fear and communication; however a substantial minority, between one-third and one-half either stated 'very much' or 'quite a bit' of a problem in regard to choking, discomfort, attracting attention, sleeping and general management (other than the suctioning). This feedback should form part of patient information, allow reflection on optimal peri-operative care and help inform the debate around selection criteria for TT.