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Am J Respir Crit Care Med. 2015 Aug 15;192(4):446-54. doi: 10.1164/rccm.201502-0239OC.

Trends in Tracheostomy for Mechanically Ventilated Patients in the United States, 1993-2012.

Author information

1
1 The Pulmonary Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
2
2 VA Boston Healthcare System, Boston, Massachusetts.
3
3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; and.
4
4 Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, Massachusetts.

Abstract

RATIONALE:

National trends in tracheostomy for mechanical ventilation (MV) patients are not well characterized.

OBJECTIVES:

To investigate trends in tracheostomy use, timing, and outcomes in the United States.

METHODS:

We calculated estimates of tracheostomy use and outcomes from the National Inpatient Sample from 1993 to 2012. We used hierarchical models to determine factors associated with tracheostomy use among MV patients.

MEASUREMENTS AND MAIN RESULTS:

We identified 1,352,432 adults who received tracheostomy from 1993 to 2012 (9.1% of MV patients). Tracheostomy was more common in surgical patients, men, and racial/ethnic minorities. Age-adjusted incidence of tracheostomy increased by 106%, rising disproportionately to MV use. Among MV patients, tracheostomy rose from 6.9% in 1993 to 9.8% in 2008, and then it declined to 8.7% in 2012 (P < 0.0001). Increases in tracheostomy use were driven by surgical patients (9.5% in 1993; 15.0% in 2012; P < 0.0001), with little change among nonsurgical patients (5.8% in 1993; 5.9% in 2012; P < 0.0001). Over time, tracheostomies were performed earlier (median, 11 d in 1998; 10 d in 2012; P < 0.0001), whereas hospital length of stay declined (median, 39 d in 1993; 26 d in 2012; P < 0.0001), discharges to long-term facilities increased (40.1% vs. 71.9%; P < 0.0001), and hospital mortality declined (38.1% vs. 14.7%; P < 0.0001).

CONCLUSIONS:

Over the past two decades, tracheostomy use rose substantially in the United States until 2008, when use began to decline. The observed dramatic increase in discharge of tracheostomy patients to long-term care facilities may have significant implications for clinical care, healthcare costs, policy, and research. Future studies should include long-term facilities when analyzing outcomes of tracheostomy.

KEYWORDS:

United States; epidemiology; mechanical ventilation; tracheostomy

Comment in

PMID:
25955332
PMCID:
PMC4595669
DOI:
10.1164/rccm.201502-0239OC
[Indexed for MEDLINE]
Free PMC Article

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