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One-Year Outcomes Following Tracheostomy for Acute Respiratory Failure

Mehta, Anuj B. MD; Walkey, Allan J. MD, MSc3,4; Curran-Everett, Douglas PhD5; Douglas, Ivor S. MD2,6

doi: 10.1097/CCM.0000000000003959
Clinical Investigation: PDF Only
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Objectives: Tracheostomy utilization has dramatically increased recently. Large gaps exist between expected and actual outcomes resulting in significant decisional conflict and regret. We determined 1-year patient outcomes and healthcare utilization following tracheostomy to aid in decision-making and resource allocation.

Design: Retrospective cohort study.

Setting: All California hospital discharges from 2012 to 2013 with follow-up through 2014.

Patients: Nonsurgical patients who received a tracheostomy for acute respiratory failure.

Interventions: None.

Measurements and Main Results: Our primary outcome was 30-day, 90-day, and 1-year mortality. We also determined hospitals readmissions rates and healthcare utilization in the first year following tracheostomy. We identified 8,343 tracheostomies during the study period. One-year mortality following tracheostomy was high, 46.5%. Older adults (≥ 65 yr) had significantly higher mortality compared with younger patients (< 65 yr) (54.7% vs 36.5%; p < 0.0001). Median survival for older adults was 175 days (95% CI, 150–202 d) compared with greater than 1 year for younger adults (adjusted hazard ratio, 1.25; 95% CI, 1.14–1.36). Within 1 year of tracheostomy, 60.3% of patients required hospital readmission. Older adults were more likely to be readmitted in the first year after tracheostomy compared with younger adults (66.1% vs 55.2%; adjusted hazard ratio, 1.19; 95% CI, 1.09–1.29). Total short-term acute care hospital costs (index and readmissions) in the first year after tracheostomy were high (mean, $215,369; SD, $160,874).

Conclusions: Long-term outcomes following tracheostomy are extremely poor with high mortality, morbidity, and healthcare resource utilization especially among older patients. Some subsets of younger patients may have better outcomes compared with the general tracheostomy population. Short-term acute care costs were extremely high in the first year following tracheostomy. If extended to the entire U.S. population, total short-term acute care hospital costs approach $11 billion dollars per year for tracheostomy-related to acute respiratory failure. These findings may aid families and surrogates in the decision-making process.

1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO.

2Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO.

3The Pulmonary Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA.

4Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston, MA.

5Division of Biostatistics, Department of Medicine, National Jewish Health, Denver, CO.

6Division of Pulmonary and Critical Care Medicine, Department of Medicine, Denver Health Hospital Association, Denver, CO.

This work was performed at National Jewish Health.

Dr. Mehta was involved in study design, data analysis, interpretation, and article preparation; he takes full responsibility for the content of the article, data analysis, and data interpretation; he had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the analysis; and he was responsible for drafting of the article. Dr. Walkey involved in data interpretation and article preparation. Dr. Curran-Everett involved in statistical and data interpretation. Dr. Douglas involved in study design, data interpretation, and article preparation. Drs. Mehta and Douglas were responsible for the study design. Drs. Mehta and Curran-Everett were responsible for the statistical analysis. All authors participated in data interpretation and contributed to critical revisions of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Drs. Mehta, Curran-Everett, Douglas received support for article research from the National Institutes of Health (NIH) (K12HL137862, RHL089897B, and R01NR016459). Dr. Walkey’s institution received funding from the NIH (R01HL136660), and he received funding from UptoDate.

For information regarding this article, E-mail: mehtaa@njhealth.org

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