Hospital Acquired Pneumonia in Temporary Tracheostomy

Trial objectives and purpose * To select patients according to a pre-defined set of inclusion and exclusion criteria * Collect pre-determined quantitative data relevant to the study question using hospital medical records * Describe patient demographic data and explore any relationship between these and the development of a HAP * Asses rates of HAP using historical medical data and pre-defined criteria that identifies hospital acquired pneumonia * Describe rates of HAP in patients who did not have a tracheostomy inserted for maxillofacial surgery with free flap reconstruction * Describe rates of HAP in patients who did have a tracheostomy inserted for maxillofacial surgery with free flap reconstruction Study Design In 2017, a new maxillofacial surgeon was appointed to Guy's \& St Thomas' NHS Foundation Trust who's preference was to insert a temporary tracheostomy for all patients undergoing oromaxillofacial surgery with free flap reconstruction. Prior to this there was a wide variation in case selection with the majority of patients undergoing overnight intubation. Since subsequent practice has now changed and all patients now undergo tracheostomy insertion within OMFS, a prospective design is not possible, therefore, a single site retrospective observational design will be adopted, allowing data from two cohorts of patients identified to be collected within a feasbile timeframe dictated by the module deadlines. Electronic and paper notes of patients from cohorts before and after the change in maxillofacial surgical practice (2014 and 2018) will be screened.