Quality of life and self-image in patients undergoing tracheostomy.

Abstract

The objective of this study is to understand trends in the Quality of Life and Self Image in patients undergoing an elective tracheostomy for non-malignant laryngeotracheal pathologies. We will also discuss the relationship between quality of life and patient demographics.
A prospective, IRB approved cohort study was conducted in a tertiary referral center. The SF-12, was used to assess the mental and physical health of patients. The 12 questions on this tool were scored to generate a Physical Composite Score(PCS) and a Mental Composite Score (MCS). A higher score indicates better health.
The retrospective arm of the study included patients who presented to the senior author and had a trachesotomy for greater than 6 months. For the prospective arm of the study patients were recruited when they were to undergo an elective tracheostomy. Patients were recruited over a 12 month period. In the prospective arm the questionnaire was administered one to seven days pre-operatively and one to three weeks postoperatively. Variables analyzed included age, gender, marital status, education, occupation and other co-morbidities.
In the prospective group, Mean PCS scores were higher in the post-trach period (38.2 ± 6.9) compared to the pre-trach period (35.4 ± 11.5). However, there is a decline in the MCS score in the post-trach period (49 ± 8.5) compared to the pre-trach period (55.4 ± 7.3). In the retrospective group, Mean PCS scores in this group was 28.5 ± 12.3 while the mean MCS score was 40.5 ± 18.3.
Planned tracheostomy is a beneficial intervention for patients with benign airway pathologies, since they experience an improvement in their physical health and the ability to perform activities of daily living. There is a decline in mental health postoperatively, which we attribute to worsening self esteem. Patients who did not undergo planned tracheostomy as seen in the retrospective group, experienced a decline in their physical and mental functioning. This can be attributed to the lack of understanding of the benefit of the procedure and poor preoperative counseling. We recommend perioperative psychological assessment to improve mental health in patients undergoing elective trachesotomies.