Avoiding prophylactic tracheostomies in head and neck surgeries with reconstructive free flaps: An institutional shift in practice

• Authors highlight an initiative to reduce tracheostomies for free flap cases. • Tracheostomy rates dropped from 92.6% to 42.7% (411 patients, pre- vs. post-2018) • Post-2018, tracheotomy risk factors included primary site and advanced nodes. • No increase in airway or flap failure complications rates in patients without tracheostomies after initiative began. In 2018, an initiative at the authors’ institution aimed at reducing routine prophylactic tracheostomies for head and neck reconstruction