Which of the following is the MOST common early complication of tracheostomy?

Explanation

## Early vs. Late Complications of Tracheostomy **Key Point:** Tracheostomy complications are classified by timing — early (within 24–48 hours to 1 week) and late (after 1 week). ### Early Complications (First Week) | Complication | Timing | Mechanism | Frequency | | --- | --- | --- | --- | | **Hemorrhage** | Immediate to 24–48 hrs | Vessel injury during insertion, slippage of ligature | **Most common early** | | Tube obstruction | Hours to days | Mucus plugging, blood clots, granulation tissue | Common | | Subcutaneous emphysema | 24–48 hrs | Air leak around tube | Common | | Tube displacement | 24–72 hrs | Inadequate fixation or coughing | Common | | Infection/cellulitis | 3–7 days | Bacterial colonization | Common | ### Late Complications (After 1 Week) | Complication | Timing | Mechanism | Risk Period | | --- | --- | --- | --- | | **Tracheal stenosis** | Weeks to months | Prolonged cuff pressure, ischemia | 2–6 weeks onward | | Tracheoinnominate artery fistula | 3–6 weeks | Tube erosion into anterior tracheal wall | Rare but fatal | | Tracheoesophageal fistula | Weeks to months | Posterior wall erosion | Rare | | Granulation tissue/polyps | 2–4 weeks | Chronic irritation | Common | **High-Yield:** Hemorrhage is the most common early complication of tracheostomy, typically occurring within the first 24–48 hours due to intraoperative vessel injury, slippage of a ligature, or erosion of a small vessel. It is managed by wound exploration, pressure, or re-ligation of the bleeding vessel. **Clinical Pearl:** Tube obstruction (from mucus plugging or blood clots) is also an early complication but is less frequent than hemorrhage in the immediate postoperative period. Tracheal stenosis and tracheoinnominate artery fistula are serious but develop later (weeks to months) and are thus classified as late complications. **Mnemonic for early complications:** **CHEST** - **C**log (tube obstruction) - **H**emorrhage *(most common early)* - **E**mphysema (subcutaneous) - **S**hift/displacement of tube - **T**racheal ring fracture / wound infection [cite: Scott-Brown's Otolaryngology 8e Ch 26; Cummings Otolaryngology 7e; Logan Turner's Diseases of the Ear, Nose and Throat 11e]