Intrahospital Transport of Adults with Tracheostomy, Laryngectomy, and other Surgical Airways: A Scoping Review of Risks, Processes, and Outcomes.

Abstract

Background: Transport of adults with tracheostomies, laryngectomies, or other surgical airways can cause airway compromise, physiologic instability, and preventable harm, yet transport practices remain inconsistent. This scoping review mapped evidence on intrahospital transport of adults with surgical airways, described transport processes and outcomes, and identified priorities for safer care.

Methods: Following PRISMA guidance, we searched six databases through March 2024 for primary studies of adults undergoing intrahospital transport with surgical airways that reported adverse events, clinical outcomes, or resource use. Reviewers independently screened studies, extracted data, and assessed risk of bias for nonrandomized studies using ROBINS-I. Findings were synthesized narratively.

Results: Of 1,118 records, six studies met inclusion criteria, including prospective cohorts, retrospective reviews, and one pre-post handoff intervention, with sample sizes from 48 to 521 patients. Cardiorespiratory alterations occurred in up to 67 percent of transports, and complications affected 28 percent of critically ill cancer transports. Compared with mechanically ventilated non-transported patients, transported patients had longer durations of ventilation, ICU stay, and hospital stay, and experienced higher ventilator-associated pneumonia and mortality rates. A structured operating room-to-ICU handoff reduced omitted information but did not change mortality or length of stay. Most studies had moderate risk of bias.

Conclusions: Intrahospital transport of adults with surgical airways is associated with instability, complications, and increased resource use, yet evidence is limited and transport processes vary widely. Multicenter studies enrolling tracheostomy patients and testing standardized, airway-focused transport bundles and structured handoffs are needed to inform best practices and improve safety.