PURPOSE: Patients requiring prolonged acute mechanical ventilation (PAMV, MV>96 hours) have hospital survival rates similar to those requiring <96 hours of MV1 and consume approximately 2/3rds of the total hospital resources devoted to MV care. We explored the association between timing of tracheostomy (trach) and hospital outcomes.
METHODS: We utilized the National Inpatient Sample (NIS)/Health Care Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ)2 data from 2002 to 2004 to identify all PAMV discharges who underwent a trach (ICD-9 procedure codes 31.1, 31.2, 31.21, 31.29). After dividing cases into quartiles by trach hospital day, we compared their hospital length of stay (HLOS), mortality and charges.
RESULTS: Of 163,746 discharges with PAMV, 36,081 underwent a trach (22%). Discharges undergoing a trach were more likely to be younger (62+17 vs. 64+17), male (54.7% vs. 52.8%), African-American (19.4% vs. 17.8%) and be in the highest quartile of illness severity (72.5% vs. 43.7%); they were also more likely to be in large (70.8% vs. 67.2%) and academic (60.4% vs. 51.2%) hospitals (p<0.0001 for each comparison). Younger discharges were more likely to receive an earlier trach than older ones (Table). Outcomes by trach day quartile are shown in table below.
CONCLUSION: The incidence rate of trach in PAMV population is 22%. Earlier trach is associated with reduced unadjusted hospital mortality, LOS and charges.
CLINICAL IMPLICATIONS: Given the resource-intensive nature of PAMV, it is important to understand how trach timing may independently contribute to clinical and economic outcomes.1 Zilberberg MD et al. Crit Care Med 2006;34:A1262 http://www.ahrq.gov/HCUP/ Accessed March15, 2007.
DISCLOSURE: Marya Zilberberg, None.