Volume–outcome relationships for tracheostomies in Australia and New Zealand Intensive Care Units: A registry-based retrospective study

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation Pub Date : 2025-03-01 DOI:10.1016/j.ccrj.2024.12.002

Prashanti Marella MD , Mahesh Ramanan MMed , Alexis Tabah PhD , Ed Litton PhD , Felicity Edwards BHlthSc , Kevin B. Laupland PhD

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引用次数: 0

Abstract

Objective

It is unknown whether a volume–outcome relationship exists for patients who receive tracheostomy in the intensive care unit (ICU) as has been observed in other healthcare settings. This study aimed to determine the average number of tracheostomies performed per intensivist per ICU in Australia and New Zealand and associations with case fatality.

Design

A retrospective cohort study of adult ICU admissions was conducted.

Setting

Data from the Australia and New Zealand Intensive Care Society Adult Patient Database and Critical care resources registry were linked and analysed over the time period extending from 01 January 2018 to 31 March 2023.

Participants

The study population included adults (aged ≥18 years) admitted to Australia and New Zealand ICUs who received tracheostomy.

Intervention

No intervention was reported.

Main outcome measures

The primary exposure variable was tracheostomies per intensivist (TPIs), which was calculated as (the number of patients who had tracheostomy inserted during their ICU admission)/(the total number of intensivists), for each site for each financial year.

Results

There were 9318 patients from 172 ICUs over a 5-year period, from January 2018 to March 2023, who received tracheostomies and were included in this analysis. The median TPI value was 3.1 (interquartile range: 1.9–4.3). Raw case fatality in the total cohort was 13.7% (1280/9318). The lowest adjusted risk of death (8.5%, 95% confidence interval: 3.63%–13.36%) was observed when the TPI value was equal to 10.3, with higher risk of death observed at lower values of TPI.

Conclusions

A volume–outcome relationship was observed between TPI value and hospital case fatality, with lower case fatality at higher TPI values across the entire range of TPI.

查看原文本刊更多论文

澳大利亚和新西兰重症监护病房气管切开术的容量-结果关系：一项基于登记的回顾性研究

目的目前尚不清楚在重症监护病房（ICU）接受气管切开术的患者是否存在与其他医疗机构观察到的体积-结果的关系。本研究旨在确定澳大利亚和新西兰ICU每位重症医师进行气管切开术的平均次数及其与病死率的关系。设计：对成人ICU住院患者进行回顾性队列研究。从2018年1月1日至2023年3月31日期间，澳大利亚和新西兰重症监护协会成人患者数据库和重症监护资源登记处的数据进行了链接和分析。研究人群包括在澳大利亚和新西兰icu接受气管切开术的成年人（年龄≥18岁）。干预：无干预报道。主要结局指标主要暴露变量为每个重症医师的气管造口术（tpi），计算为每个财政年度每个站点的（在ICU入院期间插入气管造口术的患者数量）/（重症医师总数）。结果2018年1月至2023年3月5年间，172例icu患者中有9318例接受了气管切开术。TPI值中位数为3.1（四分位数范围为1.9-4.3）。总队列的原始病死率为13.7%（1280/9318）。TPI = 10.3时校正死亡风险最低（8.5%，95%可信区间：3.63% ~ 13.36%），TPI值越低死亡风险越高。结论TPI值与住院病死率之间存在体积-结局关系，在整个TPI范围内，TPI值越高病死率越低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care and Resuscitation CRITICAL CARE MEDICINE-

CiteScore

7.70

自引率

3.40%

发文量

审稿时长

>12 weeks

期刊介绍： ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.