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Original Research: Critical Care |

Who Gets Early Tracheostomy?Early Tracheostomy Disparities: Evidence of Unequal Treatment at 185 Academic Medical Centers

Joshua J. Shaw, MD; Heena P. Santry, MD
Author and Funding Information

From the Department of Surgery and the Center for Outcomes Research-Surgical Research Scholars Program (Drs Shaw and Santry), and the Department of Quantitative Health Sciences (Dr Santry), University of Massachusetts Medical School, Worcester, MA.

CORRESPONDENCE TO: Heena P. Santry, MD, Department of Surgery, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655; email: heena.santry@umassmemorial.org


Portions of this paper were previously published in abstract form at the American Association for the Surgery of Trauma Annual Meeting, September 12, 2012, Lihue, HI.

FUNDING/SUPPORT: This research was supported by the Agency for Healthcare Research Quality [Grant R01HS22694], the Patient Centered Outcomes Research Institute [Grant ME-1310-07682], and the University of Massachusetts Clinical Scholars Award [UL1RR031982, 1KL2RR031981-01, and 8KL2TR000160-03].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(5):1242-1250. doi:10.1378/chest.15-0576
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BACKGROUND:  Although the benefits of early tracheostomy in patients dependent on ventilators are well established, the reasons for variation in time from intubation to tracheostomy remain unclear. We identified clinical and demographic disparities in time to tracheostomy.

METHODS:  We performed a level 3 retrospective prognostic study by querying the University HealthSystem Consortium (2007-2010) for adult patients receiving a tracheostomy after initial intubation. Time to tracheostomy was designated early (< 7 days) or late (> 10 days). Cohorts were stratified by time to tracheostomy and compared using univariate tests of association and multivariable adjusted models.

RESULTS:  A total of 49,191 patients underwent tracheostomy after initial intubation: 42% early (n = 21,029) and 58% late (n = 28,162). On both univariate and multivariable analyses, women, blacks, Hispanics, and patients receiving Medicaid were less likely to receive an early tracheostomy. Patients in the early group also experienced lower rates of mortality (OR, 0.84; 95% CI, 0.79-0.88).

CONCLUSIONS:  Early tracheostomy was associated with increased survival. Yet, there were still significant disparities in time to tracheostomy according to sex, race, and type of insurance. Application of evidence-based algorithms for tracheostomy may reduce unequal treatment and improve overall mortality rates. Additional research into this apparent bias in referral/rendering of tracheostomy is needed.

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