Tracheotomy outcomes and complications: a national perspective

Abstract

Objectives/hypothesis: To provide national level data on frequency of tracheotomy and complication rate and in-hospital mortality following tracheotomy.

Study design: Retrospective cohort study.

Methods: Retrospective cohort study using a public national database, the Nationwide Inpatient Sample, 2006.

Results: There were 113,653 tracheotomies performed in patients 18 years or older in 2006. The overall complication rate was 3.2%, and the in-hospital mortality rate was 19.2%. The data suggest that in-hospital mortality is usually due to the underlying illness rather than the tracheotomy. Mortality was higher in patients older than 50 years, those with cardiac conditions, particularly congestive heart failure, those with public insurance, and patients in Northeast hospitals. Patients with neurologic conditions, trauma, and upper airway infection are more likely to survive to discharge. In-hospital mortality is slightly higher in nonteaching hospitals.

Conclusions: This database study determined baseline data for the rate of complications (3.2%) for patients undergoing tracheotomy; it showed that only 80% of adult patients who underwent tracheotomy in the United States survived to discharge. Patients located in the Northeast, patients more than 50 years old, and patients with cardiac conditions were at particularly high risk for mortality. This study provides normative data for these outcomes for patient counseling and planning future quality improvement initiatives in this patient population.

Fig. 1

Multivariate analysis of mortality during the hospitalization when tracheotomy was performed, National Inpatient Sample 2006. COPD = chronic obstructive pulmonary disease.

Fig. 2

Partition classification and regression tree analysis of patient characteristic combinations associated with in-hospital mortality, National Inpatient Sample 2006.