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Laryngoscope. 2014 Aug;124(8):1801-6. doi: 10.1002/lary.24702. Epub 2014 May 7.

Outcomes of early versus late tracheostomy: 2008-2010.

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1
Department of Otolaryngology, SUNY-Upstate Medical University, Syracuse, New York, U.S.A.

Abstract

OBJECTIVES/HYPOTHESIS:

The ideal timing of tracheostomy varies. This study sought to determine demographic, management, and outcome differences in patients undergoing early tracheostomy (ET) versus late tracheostomy (LT) (<10 days vs. >10 days postintubation, respectively).

STUDY DESIGN:

Retrospective review of the 2008 to 2010 Nationwide Inpatient Sample for patients with extreme severity of illness who underwent tracheostomy.

METHODS:

Patients were subdivided based on the timing of tracheostomy placement (days 1-5, 6-10, 11-15, 16-20, 21-25). ET and LT were defined using a 10-day cutoff. Descriptive statistics were obtained for hospital and patient demographics. Multivariate models analyzed the effect of tracheostomy timing on primary outcomes of in-hospital morbidity/mortality, length of stay (LOS), and charges.

RESULTS:

A total of 124,990 tracheostomy cases met inclusion criteria. Of the total cases, 53,749 underwent ET, and 71,244 underwent LT. Significant predictors (P < .01) of ET included patient age <65 years (odds ratio [OR]: 1.136), admission to a Midwest hospital (OR: 1.430), neurologic disorder (OR: 1.196), paralysis (OR: 1.264), and admission to a government, nonfederal hospital (OR: 1.434). Significant predictors of LT included admission to a small hospital (OR: 1.150), acute respiratory failure (OR: 1.601), and acute chronic respiratory failure (OR: 1.349). The economic outcomes of hospital costs and LOS increased linearly and significantly with time to tracheostomy, as did mortality (P < .001). ET was associated with a significantly increased rate of discharge to home (P < .001) and decreased rate of sepsis (P < .001) and ventilator-associated pneumonia (P < .001).

CONCLUSIONS:

Efficient and effective healthcare delivery is paramount in today's economic climate. Identification of patients likely to need prolonged ventilator support and ET may prove to be a cost- and morbidity-saving measure and deserves further prospective examination.

KEYWORDS:

Tracheostomy; early tracheostomy; outcomes tracheostomy

PMID:
24706383
DOI:
10.1002/lary.24702
[Indexed for MEDLINE]
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