Percutaneous versus surgical tracheostomy: timing, outcomes, and charges

Anthony Yang, Mingyang L. Gray, Sean McKee, Sarah M. Kidwai, John Doucette, Stanislaw Sobotka, Mike Yao, Alfred Iloreta

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2844-2851
Number of pages8
JournalLaryngoscope
Volume128
Issue number12
DOIs
StatePublished - Dec 2018
Externally publishedYes

Keywords

  • Percutaneous tracheostomy
  • charges
  • disparity
  • outcomes
  • surgical tracheostomy
  • timing

ASJC Scopus subject areas

  • Otorhinolaryngology

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