With proper care, most people do not have issues with their tracheostomy. However, some early or late tracheostomy complications are possible.

A tracheostomy is a surgical procedure that creates a hole, called a stoma, in the front of your throat to facilitate breathing. A tube is placed into the stoma, which goes into your windpipe (trachea).

You may need a tracheostomy in an emergency if your airway is blocked or you have another health issue that impairs your breathing, such as:

  • head or neck cancer
  • injury to your voice box
  • prolonged ventilation

Usually, a tracheostomy is performed under general anesthesia, meaning you’ll be asleep during the procedure. In an emergency, you may receive local anesthesia to numb the area instead.

A tracheostomy is generally a safe procedure, but it does come with a small risk of serious complications either during or after the procedure. You can reduce many of the late complications with proper tracheostomy care.

Complications can arise during the tracheostomy procedure itself or shortly after. The following are some potential complications.

Bleeding

Bleeding is the most common complication that occurs in a tracheostomy.

A small amount of bleeding from a tracheostomy is normal and often resolves in a few days. However, bleeding can become significant enough to complicate surgery or require a blood transfusion.

In a 2020 study, researchers reported a bleeding rate of 2.9% in a group of 1,469 people treated at Detroit Medical Center from 2013–2019. Other studies have reported bleeding rates roughly around 5%.

Collapsed lung

A collapsed lung can occur if air collects around your lung. This air can disrupt the pressure gradient between your lung and the surrounding cavity and cause it to collapse. In serious cases, a collapsed lung may need surgical correction.

Collapsed lungs are a rare complication but can potentially be fatal.

Nerve injury

Though uncommon, small nerves near your windpipe can get damaged during surgery.

The laryngeal nerve is particularly vulnerable. This nerve allows you to change the tension in your vocal cords to speak, sing, and make other noises.

Infections

An infection can occur in your windpipe or the surrounding area. This can happen early on or at a later point.

An infection may require antibiotics, but infections requiring antibiotics are very rare. Localized wound care can usually treat any secretion leakage from the new stoma.

Airway fire

This is a very rare but serious complication that can occur during surgery.

The high concentration of oxygen used during general anesthesia can create an environment that promotes fire in your airways when a certain surgical tool is used.

Proper communication among the surgical team typically prevents this from happening.

General anesthesia reaction

A small number of people who receive general anesthesia have serious reactions, such as anaphylaxis or malignant hyperthermia. The surgical team monitors for these reactions following the procedure.

Death

A tracheostomy comes with a small risk of death, especially when performed in an emergency.

This risk tends to affect people with serious underlying health conditions or certain risk factors, such as a body mass index (BMI) over 40.

The following are some potential late complications that can develop after tracheostomy.

Poor healing

Some people have improper wound healing that can lead to bleeding around their tracheostomy tube.

If this happens, a doctor may need to remove your tracheostomy tube for a short while to stop the bleeding. Once the bleeding is resolved, the tube is replaced.

Blocked tracheostomy tube

Mucus and other fluids can block your tracheostomy tube, especially if you cannot clear your lungs by coughing.

Cleaning your tube regularly and following your care team’s maintenance instructions can help minimize the risk.

Inadvertent tube dislodgement

Accidental tracheostomy tube dislodgement is the most common complication that can lead to airway compromise or death. Excessively moving your head or coughing may dislodge the tube.

Collapsed or narrowed windpipe

Damage to your throat during the procedure can lead to scarring that narrows your airway. If this happens, you may need surgery to widen your windpipe.

In rare cases, the walls of your windpipe can narrow (or collapse, in rare cases) if they’re not strong enough to support themselves or your tracheostomy tube isn’t properly fitted.

Fistula

A fistula is an abnormal connection between two parts of your body that aren’t normally connected.

A rare complication of tracheostomy is a tracheoesophageal fistula, in which your esophagus and windpipe connect. It occurs in less than 5% of tracheostomies.

An even rarer complication is a trachea-innominate fistula. It occurs when your windpipe connects to the brachiocephalic trunk, a major blood vessel that supplies blood to your head.

Once your breathing tube is removed, you can develop other complications related to improper healing of your stoma, or the hole in your throat. These complications include:

  • infection
  • slow healing, which may occur from a fistula
  • scarring
  • voice changes, which can include:
    • loss of voice
    • difficulty communicating

You can minimize your risk of developing complications by following your care team’s postsurgery instructions.

Some ways you may be able to lower your risk of infection include:

Obesity is linked to higher rates of complications. A moderate body weight may also help prevent complications.

A tracheostomy can be a lifesaving procedure, but it does come with some risks of complications. Potential short-term side effects include bleeding, collapsed lung, and infections.

Long-term complications include fistulas, a blocked tracheostomy tube, and poor healing. Following your medical team’s postsurgery instructions can give you the best chance of avoiding serious complications.