Effect of Patient Demographics and Tracheostomy Timing and Technique on Patient Survival

Abstract

Objectives: The ideal timing and technique of tracheostomy vary among patients and may impact outcomes. We aim to examine the association between tracheostomy timing, placement technique, and patient demographics on survival.Study Design: Retrospective cohort study. Methods: A retrospective review was performed for all patients who underwent tracheostomy in 2016 and 2017 at one urban academic tertiary-care hospital. Kaplan-Meier curves were created based on combinations of tracheostomy timing and technique (early percutaneous, early non-percutaneous, late percutaneous, and late non-percutaneous). Cox proportional hazard models were used to determine multivariable effects of timing, technique, and other demographic factors. Primary outcome measures were tracheostomy-related mortality and overall survival. Secondary outcomes were in-hospital, 30-day, and 90-day mortality.Results: Our study included 523 patients. There were six tracheostomy-related deaths, with hemorrhage and tracheoesophageal fistula being the most common causes. Tracheostomy timing and technique combinations were not associated with differences in all-cause mortality or survival following discharge. Cox proportional hazard models showed that Charlson Comorbidity Index (CCI) and unknown partner status were associated with a decrease in survival (P < .01 and P = .05, respectively). Additionally, patient age, gender, race, CCI, and body mass index were not independently associated with changes in survival.Conclusion: Late and non-percutaneous tracheostomies were associated with more tracheostomy-related deaths, but timing and technique were not associated with differences in patient survival. Multiple regression analysis showed that increased patient comorbidities, measured via CCI, and unknown partner status were independently associated with decreased survival. Proceduralists should discuss timing, technique, and patient social factors together with the medical care team when constructing plans for postdischarge management.

Factors Associated With Otolaryngologists Performing Tracheotomy

“…A few studies revealed racial and ethnic differences in adult patients who received a tracheotomy [18][19][20] and in outcomes associated with tracheotomy. 21,22 A study of 86 246 patients with acute brain injury from the National Inpatient Sample database revealed that compared with White patients, Black patients had 20% increased risk of undergoing tracheotomy, Hispanic and Latino patients had 10% increased risk, and Asian patients had 8% increased risk. 20 Furthermore, in a retrospective study of 523 tracheotomies performed at a single institution, multi- variable analyses accounting for age, sex, race and ethnicity, insurance status, income, and comorbidities revealed that Hispanic or Latino ethnicity was associated with increased odds of 30-day mortality after tracheotomy (OR, 4.43; 95% CI, 1.26-15.60).…”

Voice, Swallow, and Airway Impairment After Late Tracheostomy: Defining Features of COVID‐19 Survivorship

“…1 Although recent studies have considered tracheostomy and optimal timing, [2][3][4] this study is among the first to report primary data on voice, swallowing, and breathing outcomes in patients who underwent tracheostomy for COVID-19 respiratory failure. 4 The study, which provides much needed patient-and clinician-reported measures, underscores the critical role of multidisciplinary teamwork. It also raises pressing questions on how to reduce the incidence and severity of device-related pressure injury during intensive care unit (ICU) stay.…”

Early prediction of hospital outcomes in patients tracheostomized for complex mechanical ventilation weaning

“…Recent French guidelines addressed this important question, also underlining that additional data is needed [15]. Only higher body weight [16], presence of comorbidities [17][18][19] and albuminemia levels [20] have previously been associated with worse outcome in tracheostomized patients. In practice, ICU clinicians use clinical judgment and the general health status of the patient to decide whether to perform tracheostomy.…”