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Percutaneous versus surgical tracheostomy: timing, outcomes, and charges
Author(s) -
Yang Anthony,
Gray Mingyang L.,
McKee Sean,
Kidwai Sarah M.,
Doucette John,
Sobotka Stanislaw,
Yao Mike,
Iloreta Alfred
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27334
Subject(s) - medicine , percutaneous , retrospective cohort study , confidence interval , odds ratio , surgery , cohort study
Objectives/Hypothesis The purpose of this study was to compare timing of procedure, patient characteristics, outcomes, and charges for patients who underwent percutaneous versus surgical tracheostomy. Study Design Retrospective cohort study. Methods A retrospective analysis was performed for all patients who underwent tracheostomy in 2015 to 2016 in New York State. Patients were identified using International Classification of Diseases, 10th Revision, Clinical Modification codes and stratified to the type of tracheostomy performed. The primary outcome of interest was mortality at index stay. Secondary outcomes of interest included length of stay and total hospitalization charges. Results Of the 8,682 patients, 2,488 (28.7%) underwent percutaneous and 6,194 (71.3%) underwent surgical tracheostomy. At hospitals where both procedures were performed, percutaneous tracheostomy patients were older, had more comorbidities, and had lower income ( P < .05). Timing of the tracheostomy relative to admission did not affect the type of tracheostomy performed. While controlling for patient characteristics and complications during the visit, percutaneous tracheostomy was associated with increased mortality (odds ratio [OR]: 1.17, 95% confidence interval [CI]: 1.03‐1.33, P = .0153) and increased hospital charges (OR: + 7.76%, 95% CI: 5.4‐10.11, P < .0001). Length of stay was not affected by procedure type. Conclusions Surgical tracheostomies are more commonly performed than percutaneous tracheostomies across New York State. Older, lower‐income, and sicker patients have a higher chance of receiving percutaneous tracheostomies. Percutaneous approaches were associated with statistically significant increased mortality and higher charges despite no difference in length of stay. Further studies are needed to determine if these differences in outcomes are clinically significant. Level of Evidence NA Laryngoscope , 128:2844–2851, 2018