Four hundred twenty-nine patients were included in the study. Another 80 patients who had undergone tracheostomies were excluded: charts were unavailable (n = 8); tracheostomy was performed as part of a planned surgical procedure (n = 12), for emergency airway control (n = 8), in pediatric patients < 18 years old (n = 23), for secretion management (n = 15), or for upper airway obstruction in an intubated patient (n = 11); or if the patient already had a tracheostomy on admission to the hospital (n = 3). Charts were reviewed for age; sex; marital status (married, single, widowed, divorced); race (white, black, other); insurance status (none, private commercial, Medicare, Medicaid, Medicaid pending on admission, health maintenance organization/preferred provider organization); height; weight; hospital admitting service (internal medicine, family practice, surgery); admission diagnosis; presence of closed head injury on admission; medical history of hypertension, coronary artery disease, peripheral vascular disease, myocardial infarction, stroke, COPD, diabetes mellitus, and cancer; admission and nadir (lowest) hemoglobin; admission and peak creatinine; acute renal failure (peak creatinine > 2 mg/dL if normal on admission, else increased by ≥ 1 mg/dL if elevated on admission)9
; transfusion; dialysis (none, acute, chronic); insertion of an inferior vena cava filter; insertion of a surgical feeding tube (open gastrostomy, open jejunostomy, both open gastrostomy and jejunostomy, percutaneous endoscopic gastrostomy, or none); type of operation (craniotomy, major vascular [operations on the abdominal aorta or carotid, iliac, or femoral arteries]; thoracic; abdominal; major orthopedic [operations on the pelvis, femur, or tibia, or hip or knee replacement]; other [all remaining operations]); dates of admission, tracheostomy, last day of mechanical ventilation, and discharge; discharge location (home, extended-care facility, rehabilitation hospital, another acute care hospital, hospice facility, or death); respiratory status on discharge (partial mechanical ventilation [on tracheostomy collar for at least 6 h/d], mechanical ventilation dependent [receiving at least 18 h/d], liberated from mechanical ventilation but tracheostomy tube still present, liberated from mechanical ventilation and tracheostomy tube decannulated); the ability to walk in the hall; and nutrition (total parental nutrition, tube feedings, neither). Death after discharge was determined from hospital records, telephone calls, and Social Security Death Index. Survivors were contacted by telephone, and if they consented to participate, were administered the Short Form-36 (SF-36).12
Direct variable cost for each patient’s care was obtained from the internal accounting system of the hospital.