PURPOSE: Percutaneous tracheostomy is more commonly being performed at bed side by interventional pulmonologist and intensivists through out United States. It is one of the oldest surgical procedures performed by general surgery in the Operating room which places increase burden on nursing and other ancillary staff. We reviewed the safety data percutaneous tracheostomies done at our institution, a growing pulmonary tertiary care institute with no interventional pulmonary fellowship program.
METHODS: Our department adopted the Percutaneous tracheostomy as an alternative to open tracheostomy in February 2009, primarily done by selective pulmonologist with specific interest and experience in interventional pulmonary procedures. To assess safety, operative time, and cost, data was gathered from the retrospective analysis of patients`s charts who had open or percutaneous tracheostomy since February 2009. Patient`s data was analyzed for indications for tracheostomy, length of operation, morbidity, post operative complication and cost. Tracheostomy was performed percutaneously in 24 patients and by a standard open technique in 80 patients. The length of operation was 25 5 minutes and 60 10 minutes for percutaneous and open tracheostomy, respectively (P < 0.05). Perioperative complications of bleeding at the trach site requiring other specialty involvement after percutaneous tracheotomy was found in one out of 23 patients. The mean operating room costs per patient were$1569±$157 and ;$3172±$114; P<.001 for percutaneous and open tracheostomy, respectively. A survery was also distributed among the nursing staff and respiratory therapists to assess the burden of work on ancillary staff.
RESULTS: Percutaneous tracheostomy led to significantly decreased intraoperative time and reduced morbidity in patients when compared to open tracheostomy.Percutaneous tracheostomy resulted in decrease cost along with decrease physical burden on health care personnel.
CONCLUSION: Percutaneous tracheotomy in an expert hand is a safe and cost effective procedure and should be considered as the first line procedure where appropriate and depending on the experience of personnel at each institution.
CLINICAL IMPLICATIONS: Cost effectivness of this procedure makes it the procedure of choice in experenced hands with low risk of complications.
DISCLOSURE: Sanober Butt, No Financial Disclosure Information; No Product/Research Disclosure Information