A. A. ARISHI1, A. Mohamed Ahmed1, W. Qu1, F. C. Brunicardi1, M. M. Nazzal1, J. Ortiz1, M. F. Osman1 1University Of Toledo Medical Center,Surgery,Toledo, OH, USA
Introduction:
Tracheostomy is a high-risk procedure that is almost always performed on patients in respiratory failure. The purpose of this study was to investigate factors associated with early mortality after tracheostomy.
Methods:
Adult patients with respiratory failure who underwent tracheostomy were selected from the National Inpatient Sample (NIS) database (2008-2012) of the Healthcare Cost and Utilization Project (HCUP). All the diagnoses and procedures were identified by ICD-9-CM codes. Patients were assigned into futile group (FG, died within 30 days after admission) and non-futile group (NFG). Demographics, hospital characteristics, and risk factors were compared between the 2 groups. The indicators of early mortality were identified by multivariable logistic regression. All statistical analyses were done with IBM SPSS statistical software ver. 24. Type I error level was set at 0.05.
Results:
A total of 86,303 patients (7,007/8.1% in FG, and 79,296/91.9% in NFG) were included in this study. The overall mortality rate was 16% with an 8.1% 30-day mortality rate. FG patients were significantly older (65±15 vs. 61±17 years), more likely to be male (57.8 vs. 56.2%), Caucasian (66.1 vs. 63.8%), and were covered by Medicare insurance (57.8 vs. 51.4%) than NFG patients (all p values <.001). In addition to age (adjusted OR=1.018, 95%CI 1.016-1.020, P<.001) and male gender (adjusted OR=1.093, 95%CI 1.038-1.151, p<.001), septicemia/sepsis, coagulopathy, liver disease, renal failure, fluid/electrolyte imbalance, and congestive heart failure were identified as among the most important predictors for early mortality after tracheostomy in multivariable analysis (Table 1).
Conclusion:
16% of the patients with respiratory failure will die after tracheostomy during their hospital stay, and about half of these deaths occur within 30 days after admission. In addition to older age and male gender, severe infections, coagulopathy, liver disease, renal failure, fluid/electrolyte imbalance, and congestive heart failure would also significantly increase the risk of early mortality. This study demonstrates that tracheostomy is a high-risk procedure associated with a significant mortality rate, which should be reviewed pre-operatively with the patient and the family.
