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Tracheotomy outcomes and complications: A national perspective§

Authors

  • Rahul K. Shah MD,

    Corresponding author
    1. Division of Otolaryngology, Children's National Medical Center, George Washington University Medical School, Washington, DC
    • Division of Otolaryngology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010
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  • Lina Lander ScD,

    1. Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
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  • Jay G. Berry MD,

    1. Complex Care Service, Division of General Pediatrics, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
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  • Brian Nussenbaum MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
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  • Albert Merati MD,

    1. Division of Laryngology, Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington
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  • David W. Roberson MD

    1. Department of Otolaryngology, Program for Patient Safety and Quality, Children's Hospital Boston, Department of Otology and Laryngology Harvard Medical School, Boston, Massachusetts, U.S.A.
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  • Presented in part at the Annual Meeting of the American Bronchoesophagological Association, Chicago, Illinois, U.S.A., May 1, 2011.

  • Dr. Berry was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development career development award (K23 HD058092). The authors have no other funding, financial relationships, or conflicts of interest to disclose.

  • §

    Editor's Note: This Manuscript was accepted for publication May 2, 2011.

Abstract

Objectives/Hypothesis:

To provide national level data on frequency of tracheotomy and complication rate and in-hospital mortality following tracheotomy.

Study Design:

Retrospective cohort study.

Methods:

Retrospective cohort study using a public national database, the Nationwide Inpatient Sample, 2006.

Results:

There were 113,653 tracheotomies performed in patients 18 years or older in 2006. The overall complication rate was 3.2%, and the in-hospital mortality rate was 19.2%. The data suggest that in-hospital mortality is usually due to the underlying illness rather than the tracheotomy. Mortality was higher in patients older than 50 years, those with cardiac conditions, particularly congestive heart failure, those with public insurance, and patients in Northeast hospitals. Patients with neurologic conditions, trauma, and upper airway infection are more likely to survive to discharge. In-hospital mortality is slightly higher in nonteaching hospitals.

Conclusions:

This database study determined baseline data for the rate of complications (3.2%) for patients undergoing tracheotomy; it showed that only 80% of adult patients who underwent tracheotomy in the United States survived to discharge. Patients located in the Northeast, patients more than 50 years old, and patients with cardiac conditions were at particularly high risk for mortality. This study provides normative data for these outcomes for patient counseling and planning future quality improvement initiatives in this patient population.Laryngoscope, 122:25–29, 2012

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