The safety and clinical outcomes of open tracheostomy performed by residents in an academic center: A retrospective cohort study.

BACKGROUND: Open surgical tracheostomy is a fundamental airway procedure in otolaryngology and an essential component of surgical training. Balancing resident autonomy with patient safety remains a central challenge in academic practice. Evidence evaluating outcomes across different levels of resident experience and supervision remains limited. METHODS: A retrospective cohort study was conducted at a tertiary academic center including all open tracheostomy procedures performed between January 2020 and December 2023. Procedures were categorized according to operator seniority as attending surgeons, senior residents (≥ 48 months of training), and junior residents (< 48 months). Subgroup analyses evaluated the impact of supervision during resident-performed procedures. The primary outcome was postoperative complications. Secondary outcomes included operative duration, mortality, and survival. Multivariable logistic regression was used to identify predictors of complications, and Kaplan-Meier analysis assessed survival. RESULTS: A total of 288 tracheostomy procedures were included: 81 (28.1%) performed by attending surgeons, 82 (28.5%) by senior residents, and 125 (43.4%) by junior residents. Overall postoperative complications occurred in 47 patients (16.3%) and were not associated with operator seniority (p = 0.133). In multivariable analysis, diabetes (OR 4.76, p = 0.043) and prior neck surgery (OR 16.22, p = 0.022) independently predicted complications, whereas operator seniority did not. Among resident-performed procedures, complication rates were similar between supervised and unsupervised cases (13.3% vs 15.5%, p = 0.592). Operative duration, complications, and 30-day mortality did not differ across supervision groups. Early tracheostomy (≤ 7 days after intubation) was associated with improved survival. CONCLUSION: Resident-performed open tracheostomy demonstrates outcomes comparable to attending surgeons, regardless of supervision status. These findings support structured training models allowing graduated resident autonomy while maintaining patient safety. Patient factors and tracheostomy timing appear more influential determinants of outcomes than operator experience.