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ORL J Otorhinolaryngol Relat Spec. 2020 Feb 7:1-8. doi: 10.1159/000505130. [Epub ahead of print]

Tracheostomy Complications in the Emergency Department: A National Analysis of 38,271 Cases.

Author information

1
Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA, maxwell3@stanford.edu.
2
Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, USA.
3
Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA.
4
Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA.

Abstract

BACKGROUND:

Greater than 100,000 tracheotomies are performed annually in the USA, yet little is known regarding patients who present to the emergency department (ED) with tracheostomy complications.

OBJECTIVES:

To characterize patient and hospital characteristics, outcomes, and charges associated with tracheostomy complications and to identify predictors of admission and mortality.

METHODS:

The 2009-2011 Nationwide Emergency Department Sample (NEDS) was queried for patients with a principle diagnosis of tracheostomy complication. A descriptive analysis was performed and multivariable logistic regression was used to identify predictors of admission and mortality.

RESULTS:

A total of 69,371 nationwide visits to the ED had tracheostomy complication as an associated ICD-9 diagnosis, of which 55.2% (n = 38,293) carried a primary diagnosis of tracheostomy complication. Unspecified tracheostomy complications were most common (61.4%), followed by mechanical complications (31.3%), and lastly by tracheostomy infections (7.3%). Pediatric patients were significantly more likely to have tracheostomy infections than adults (p < 0.0001). A total of 35.5% of patients with tracheostomy complications were admitted to the hospital, and death occurred with 1.4% of visits. Patients from higher-income ZIP codes had increased odds of admission (adjusted odds ratio [OR]: 1.35; p = 0.0009), as did patients with tracheostomy infections (OR: 4.425; p < 0.0001). Patients with tracheostomy infections (OR: 3.14; p = 0.0062) and unspecified tracheostomy complications (OR: 2.00; p = 0.0076) had increased odds of mortality.

CONCLUSION:

These findings may help improve overall outcomes amongst patients with tracheostomies by preventing unnecessary ED admissions and improving healthcare provider preparedness and awareness.

KEYWORDS:

Complications; Emergency department; Head and neck cancer; Tracheostomy

PMID:
32036376
DOI:
10.1159/000505130

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