Tracheostomy insertion & closure

A tracheostomy is a surgical opening created in the front of the neck into the windpipe (trachea) to assist with breathing. A tracheostomy tube is inserted through this opening to maintain the airway.

It may be required for prolonged ventilation, airway obstruction, severe trauma, neurological conditions, head and neck surgery, or difficulty clearing secretions.

Tracheostomy closure is performed when the tracheostomy is no longer required and the patient is breathing safely without assistance.

What to expect

Before Your Surgery

  • Authorization should be obtained prior to surgery and will be done by the hospital or the rooms staff depending on whether you are an in- or outpatient.
  • Make sure that you have been fasting for solid foods for at least 6 hours prior to your surgery and for clear liquids or water for at least 2 hours prior to your surgery. Discuss your chronic medications with your doctor or hospital staff prior to your surgery as you usually are allowed to take chronic medications the day of surgery, barring diabetic medication the day of the procedure. If you are taking any blood thinning medication please discuss these in detail with your doctor as special arrangements need to be made for these.
  • Blood tests, imaging, airway evaluation, and anaesthetic assessment may be required before surgery.

Day of Surgery

You will be admitted to hospital and taken to theatre. After the procedure, you will be monitored in recovery, high care, or ICU depending on your condition.

You may require oxygen, suctioning, humidification, physiotherapy, and specialised tracheostomy nursing care.

Procedure

The procedure is performed under general anaesthesia or, in selected cases, under local anaesthesia with sedation.

For tracheostomy insertion:

  • A small incision is made in the front of the neck
  • The trachea is identified and opened
  • A tracheostomy tube is inserted and secured in place

For tracheostomy closure:

  • The tube is removed once safe swallowing and breathing are confirmed
  • The opening may be allowed to close naturally or surgically closed depending on the case and duration of the tracheostomy

Procedure Length

Tracheostomy insertion usually takes 30–60 minutes.
Tracheostomy closure usually takes 15–45 minutes, depending on the method used.

Possible Complications

  • Possible complications include bleeding, infection, air leak, tube blockage, accidental tube displacement, scarring, difficulty swallowing, injury to nearby structures, persistent tracheostomy opening, narrowing of the airway, voice changes, and unintended damage to surrounding structures.

Duration of Hospital Stay

  • Hospital stay depends on the reason for the tracheostomy and the patient’s medical condition.
  • Some patients may require only a short admission, while critically ill patients may require prolonged ICU or hospital care.
  • Tracheostomy closure is often performed as a day-case or short-stay procedure if uncomplicated.

Discharge Instructions

  • Keep the tracheostomy site clean and dry. Follow all instructions regarding tube care, suctioning, humidification, and dressing changes.
  • Avoid water entering the tracheostomy. Attend all tube changes and follow-up appointments.
  • After closure, keep the wound clean and dry and monitor for swelling, breathing difficulty, or air leakage.
  • Please contact the rooms urgently if you develop fever, bleeding, worsening breathing difficulty, increasing swelling, excessive secretions, tube blockage, wound discharge, or voice changes.

Return to Activities

  • Activity depends on the patient’s general condition and the reason for the tracheostomy.
  • Avoid strenuous activity, swimming, dust exposure, or smoking while the tracheostomy is present or healing.
  • Speech and swallowing therapy may be required in selected cases.

Back to Work Estimation

  • Return to work depends on the underlying medical condition and recovery.
  • Minor uncomplicated closure procedures may allow return to desk work within 1–2 weeks, while complex medical conditions may require significantly longer recovery.

Follow-Up and Results Discussion

A follow-up appointment may be arranged 5–7 days after surgery for wound review, tube assessment, or dressing review.

A further follow-up is usually arranged 10–14 days after surgery for wound assessment, suture removal if required, and review of breathing, swallowing, and healing progress.

Histology discussion will occur if tissue was sent for analysis.