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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.

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Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA,
Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA.
Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA.



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.


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


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.


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.


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


Complications; Emergency department; Head and neck cancer; Tracheostomy


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