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Are there variations in timing to tracheostomy in a tertiary academic medical center?

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BACKGROUND It is unclear what drives variation in timing to tracheostomy among different patients. METHODS Age, ethnicity, admission service, and income were retrospectively collected for patients undergoing tracheostomy in a… Click to show full abstract

BACKGROUND It is unclear what drives variation in timing to tracheostomy among different patients. METHODS Age, ethnicity, admission service, and income were retrospectively collected for patients undergoing tracheostomy in a Level 1 trauma center from 2007 to 2017. The primary outcome was time to tracheostomy with early tracheostomy (ET) or late tracheotomy (LT) defined as 3-7 or ≥ 10 days post-intubation, respectively. Secondary outcomes included length of stay (LOS), ventilator associated pneumonia, and mortality. RESULTS Among 1,640 patients, more men had ET compared to women (30% vs 28%; p = 0.05). The mean time to tracheostomy was 11.2 ± 7.7 days. Neurology and trauma patients had significantly shorter time to tracheostomy compared to other services. Age, ethnicity, and income showed no differences in timing to tracheostomy. Patients who underwent LT had a longer LOS (46 vs 32 days, p < 0.01) and higher mortality (19% vs 13% p < 0.01). CONCLUSIONS There were no disparities in timing to tracheostomy based on age, ethnicity, or income. We detected a hesitation in performing tracheostomies by certain providers with shorter LOS and improved mortality in ET.

Keywords: age ethnicity; variations timing; timing tracheostomy; time tracheostomy; tracheostomy; center

Journal Title: American journal of surgery
Year Published: 2020

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