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Trends in Tracheostomy for Mechanically Ventilated Patients in the United States, 1993-2012.
Am J Respir Crit Care Med. 2015 May 8;
Authors: Mehta AB, Syeda SN, Bajpayee L, Cooke CR, Walkey AJ, Wiener RS
Abstract
RATIONALE: National trends in tracheostomy for mechanical ventilation (MV) patients are not well characterized.
OBJECTIVES: To investigate trends in tracheostomy utilization, timing, and outcomes in the US.
METHODS: We calculated estimates of tracheostomy utilization and outcomes from the National Inpatient Sample from 1993-2012. We used hierarchical models to determine factors associated with tracheostomy use among MV patients.
MAIN RESULTS: We identified 1,352,432 adults who received tracheostomy from 1993-2012 (9.1% of MV patients). Tracheostomy was more common in surgical patients, men, and racial/ethnic minorities. Age-adjusted incidence of tracheostomy increased by 106%, rising disproportionately to MV utilization. Among MV patients, tracheostomy rose from 6.9% in 1993, to 9.8% in 2008, and then declined to 8.7% in 2012 (p<0.0001). Increases in tracheostomy utilization were driven by surgical patients (9.5% in 1993; 15.0% in 2012, p<0.0001), with little change among non-surgical patients (5.8% in 1993; 5.9% in 2012, p<0.0001). Over time, tracheostomies were performed earlier (median 11 days in 1998; 10 days in 2012, <0.0001), while hospital length of stay declined (median 39 days in 1993; 26 days in 2012, p<0.0001), discharges to long-term facilities increased (40.1% vs 71.9%, p<0.0001), and hospital mortality declined (38.1% vs 14.7%, p<0.0001).
CONCLUSIONS: Over the past two decades, tracheostomy utilization rose substantially in the US until 2008 when utilization began to decline. The observed dramatic increase in discharge of tracheostomy patients to long-term care facilities may have significant implications for clinical care, healthcare costs, policy, and research. Future studies should include long-term facilities when analyzing outcomes of tracheostomy.
PMID: 25955332 [PubMed - as supplied by publisher]