Tracheostomies for respiratory failure are associated with a high inpatient mortality: a potential trigger to reconsider goals of care
Introduction Acute care surgeons are frequently consulted for tracheostomy placement in the intensive care unit (ICU). Tracheostomy may facilitate ventilator weaning and improve physical comfort. Short-term outcomes after tracheostomy are not well studied. We hypothesize that a high proportion of IC...
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BMJ Publishing Group
2024-10-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/9/1/e001105.full |
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| author | Mackenzie Cook Cameron Colbert Aaron D Streblow Scott P Sherry Konrad Dobbertin |
| author_facet | Mackenzie Cook Cameron Colbert Aaron D Streblow Scott P Sherry Konrad Dobbertin |
| author_sort | Mackenzie Cook |
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| description | Introduction Acute care surgeons are frequently consulted for tracheostomy placement in the intensive care unit (ICU). Tracheostomy may facilitate ventilator weaning and improve physical comfort. Short-term outcomes after tracheostomy are not well studied. We hypothesize that a high proportion of ICU patients who underwent tracheostomy died prior to discharge. These data will help guide clinical decision-making at a key pivot point in care.Methods We identified 177 mixed ICU patients who received a tracheostomy for respiratory failure between January 2013 and December 2018. We excluded patients with trauma. Patient information was collected and comparisons made with univariable and multivariable statistics.Results Of the 177 patients who underwent a tracheostomy for respiratory failure, 45% were women, median age was 63 (51–71) years. Of this group 18% died prior to discharge, 63% were discharged to a care facility and only 16% discharged home. Compared with survivors, patients with tracheostomies who died during their admission were older, age 69 (64–76) versus 61 (49–71) years (p<0.01) on univariable analysis. In this model, no single comorbid condition or length of stay (LOS) variable was predictive of death before discharge. A multivariable model controlling for covariation similarly identified age, as well as a longer ICU LOS of 34 (20–49) versus 23 (16–31) days (p=0.003) as factors associated with increased likelihood of death before discharge.Conclusions Tracheostomy placement in a mixed ICU population is associated with a nearly 20% inpatient mortality and the vast majority of surviving patients were discharged to a care facility. This suggests that the need for tracheostomy could be considered a trigger for re-evaluation of patient goals. The high risk of death due to underlying illness and high intensity care after their hospitalization emphasize the need for clear advanced care planning discussions around the time of tracheostomy placement.Level of Evidence Level IV, Retrospective cohort study. |
| format | Article |
| id | doaj-art-5033864cc22d47c6a7a8f0e05f8f8472 |
| institution | Kabale University |
| issn | 2397-5776 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-5033864cc22d47c6a7a8f0e05f8f84722025-01-24T10:45:11ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762024-10-019110.1136/tsaco-2023-001105Tracheostomies for respiratory failure are associated with a high inpatient mortality: a potential trigger to reconsider goals of careMackenzie Cook0Cameron Colbert1Aaron D Streblow2Scott P Sherry3Konrad Dobbertin4Department of Surgery, Oregon Health & Science University, Portland, Oregon, USADepartment of Surgery, Oregon Health & Science University, Portland, Oregon, USADepartment of Surgery, Oregon Health & Science University, Portland, Oregon, USADepartment of Surgery, Oregon Health & Science University, Portland, Oregon, USADepartment of Surgery, Oregon Health & Science University, Portland, Oregon, USAIntroduction Acute care surgeons are frequently consulted for tracheostomy placement in the intensive care unit (ICU). Tracheostomy may facilitate ventilator weaning and improve physical comfort. Short-term outcomes after tracheostomy are not well studied. We hypothesize that a high proportion of ICU patients who underwent tracheostomy died prior to discharge. These data will help guide clinical decision-making at a key pivot point in care.Methods We identified 177 mixed ICU patients who received a tracheostomy for respiratory failure between January 2013 and December 2018. We excluded patients with trauma. Patient information was collected and comparisons made with univariable and multivariable statistics.Results Of the 177 patients who underwent a tracheostomy for respiratory failure, 45% were women, median age was 63 (51–71) years. Of this group 18% died prior to discharge, 63% were discharged to a care facility and only 16% discharged home. Compared with survivors, patients with tracheostomies who died during their admission were older, age 69 (64–76) versus 61 (49–71) years (p<0.01) on univariable analysis. In this model, no single comorbid condition or length of stay (LOS) variable was predictive of death before discharge. A multivariable model controlling for covariation similarly identified age, as well as a longer ICU LOS of 34 (20–49) versus 23 (16–31) days (p=0.003) as factors associated with increased likelihood of death before discharge.Conclusions Tracheostomy placement in a mixed ICU population is associated with a nearly 20% inpatient mortality and the vast majority of surviving patients were discharged to a care facility. This suggests that the need for tracheostomy could be considered a trigger for re-evaluation of patient goals. The high risk of death due to underlying illness and high intensity care after their hospitalization emphasize the need for clear advanced care planning discussions around the time of tracheostomy placement.Level of Evidence Level IV, Retrospective cohort study.https://tsaco.bmj.com/content/9/1/e001105.full |
| spellingShingle | Mackenzie Cook Cameron Colbert Aaron D Streblow Scott P Sherry Konrad Dobbertin Tracheostomies for respiratory failure are associated with a high inpatient mortality: a potential trigger to reconsider goals of care Trauma Surgery & Acute Care Open |
| title | Tracheostomies for respiratory failure are associated with a high inpatient mortality: a potential trigger to reconsider goals of care |
| title_full | Tracheostomies for respiratory failure are associated with a high inpatient mortality: a potential trigger to reconsider goals of care |
| title_fullStr | Tracheostomies for respiratory failure are associated with a high inpatient mortality: a potential trigger to reconsider goals of care |
| title_full_unstemmed | Tracheostomies for respiratory failure are associated with a high inpatient mortality: a potential trigger to reconsider goals of care |
| title_short | Tracheostomies for respiratory failure are associated with a high inpatient mortality: a potential trigger to reconsider goals of care |
| title_sort | tracheostomies for respiratory failure are associated with a high inpatient mortality a potential trigger to reconsider goals of care |
| url | https://tsaco.bmj.com/content/9/1/e001105.full |
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