Percutaneous dilatational tracheostomy (PDT) is a safe and cost effective alternative to open tracheostomy. There are few data identifying predictors of short-term mortality in patients receiving PDT.
Hospital records of patients who underwent PDT from July 2005 through June 2008 were reviewed. Social Security Death Index was used to establish dates of death. Data were analyzed for in-hospital, 30 day and 6 month mortality after PDT by clinical and demographic characteristics using multivariate logistic regression.
The in-hospital mortality rate for 488 patients analyzed was 30%, including one directly related to PDT. The 30 day and 6 month post procedure mortality was 19% and 40% respectively. Multivariate analysis demonstrated lower odds ratios for in-hospital death for trauma patients (OR 0.09; P=0.01) and patients with a new stroke (OR, 0.45; P = 0.015). Similar outcomes were seen at 30 days for trauma patients (OR, 0.07; P = 0.01) and a new stroke (OR, 0.4; P=0.033). An oncological diagnosis was associated with a trend toward higher in-hospital mortality (OR, 1.79; P = 0.061) and a significantly higher mortality at 30 days (OR, 2.12; P = 0.021). Implantation of a ventricular assist device (VAD) was associated with higher in-hospital mortality (OR, 4.93; P = 0.001) and 30 day mortality (OR, 3.09; P=0.015).
Although the majority of patients were alive at hospital discharge, the in-house mortality rate was 30%. Our study supports that trauma patients and those with a new stroke have a longer survival while oncology and VAD patients have significantly higher short-term mortality rates.
There is significant clinical heterogeneity in patients undergoing PDT that should be considered when deciding which patients are appropriate for the procedure. Not all patients will benefit equally from PDT. Future studies should investigate the impact of PDT on quality of life, even in patients with high short-term mortality.
Daniel Gilstrap, No Financial Disclosure Information; No Product/Research Disclosure Information