I. Yi1, G. Ortega3, M. F. Nunez3, E. E. Cornwell2, M. Williams2 1Howard University College Of Medicine,Washington, DC, USA 2Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA 3Howard University College Of Medicine,Clive O. Callender, MD Howard-Harvard Outcomes Research Center,Washington, DC, USA
Introduction:
Optimal timing of surgical airways in admitted patients requiring ventilator support remains elusive. Previous studies have classified tracheostomies as “early” and “late” using cut-off dates ranging from 5 to 10 days on ventilator to assess mortality. Our study aims to investigate mortality rates based on the day of the procedure and the number of days on a ventilator using a national database.
Methods:
We performed a retrospective analysis of the National Inpatient Sample (NIS) 2005–2014. We included non-trauma adult patients who underwent a surgical airway (ICD-9 31.1) procedure within 28 days of admission. We excluded patients who underwent elective and permanent tracheostomies (ICD 31.2), transfers from another facility, and patients requiring a surgical airway for the management of another localized disease (e.g. cancer or disease of the oropharynx and upper airway). We analyzed the day(s) from admission and/or day(s) from endotracheal intubation to the day the surgical airway was performed. Descriptive statistics were obtained for patient demographics, co-morbidities, length of stay, and mortality. Unadjusted and adjusted analyses were performed where appropriate to assess mortality adjusting for age, race/ethnicity, insurance, median household income, hospital type, and co-morbidities.
Results:
A total of 88,890 patients underwent a surgical airway. Most patients were White (60.5%), male (53.1%), had a mean age of 62.3 years. Most patients presented with respiratory failure (83.1%), followed by heart diseases (56.3%), sepsis (49.0%) and pneumonia (48.8%). Over the 28-days period, the average surgical airway was performed on day 13, and patients were intubated after 10 days. Most surgical airways were performed at teaching (57.7%) and urban facilities (95.9%), with an 18.9% overall mortality rate. The mortality rate was 15.7% on day 0 and 27.8% on day 28 for day of procedure, with the lowest rate at 12.6% on day 2. The mortality rate was 20.4% and 24.8% for 0 and 28 days on ventilator respectively, the lowest rate being 12.4% after 2 days on ventilator. On adjusted analysis, we found an increase by 1.6% and 1.1% in mortality rate for each day preceding the surgical airway and for each day spent on a ventilator, respectively.
Conclusion:
As time before surgical airway and number of days on ventilator increase, so does in-hospital mortality. Earlier timing of surgical airways appears to be independently associated with a modest increase in in-hospital survival compared to later surgical airways.