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Purpose <p>To propose a decision-making algorithm for preventive tracheostomy in patients with obstructive sleep apnea syndrome (OSAS) or oropharyngeal squamous cell carcinoma (OPSCC) undergoing transoral robotic surgery (TORS).</p> Methods <p>Preoperative assessment integrated clinical history with anesthesiologic scoring systems, including the ASA classification, El-Ganzouri Risk Index (EGRI), and STOP-Bang questionnaire. Additional pro-hemorrhagic factors were also considered. Based on individual risk profiles, tracheostomy was performed before or after TORS when indicated.</p> Results <p>Higher ASA and EGRI scores, coagulopathy, cardiovascular disease, hypertension, and smoking were significantly associated with increased rates of tracheostomy and postoperative bleeding.</p> Conclusions <p>Preventive tracheostomy during TORS should be considered according to the surgical plan and the patient’s overall clinical condition, particularly in cases of severe OSAS, BMI &gt; 27.5, elevated EGRI or ASA scores, anticoagulant therapy, coagulopathy, cardiovascular comorbidities, and active smoking or alcohol consumption.</p>

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Temporary tracheotomy in transoral robotic surgery (TORS): from a retrospective single-center analysis to a proposal of a decision-making algorithm

  • 期刊论文

  • 发表日期：

    2026年3月5日

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  • Luigi Marco Stringa,
  • Giuseppe Meccariello,
  • Giovanni Cammaroto,
  • Devina Chitranshi,
  • Irene Claudia Visconti,
  • Andrea De Vito

摘要

Purpose

To propose a decision-making algorithm for preventive tracheostomy in patients with obstructive sleep apnea syndrome (OSAS) or oropharyngeal squamous cell carcinoma (OPSCC) undergoing transoral robotic surgery (TORS).

Methods

Preoperative assessment integrated clinical history with anesthesiologic scoring systems, including the ASA classification, El-Ganzouri Risk Index (EGRI), and STOP-Bang questionnaire. Additional pro-hemorrhagic factors were also considered. Based on individual risk profiles, tracheostomy was performed before or after TORS when indicated.

Results

Higher ASA and EGRI scores, coagulopathy, cardiovascular disease, hypertension, and smoking were significantly associated with increased rates of tracheostomy and postoperative bleeding.

Conclusions

Preventive tracheostomy during TORS should be considered according to the surgical plan and the patient’s overall clinical condition, particularly in cases of severe OSAS, BMI > 27.5, elevated EGRI or ASA scores, anticoagulant therapy, coagulopathy, cardiovascular comorbidities, and active smoking or alcohol consumption.