Evolution of tracheostomy practices after the COVID-19 pandemic: The fast lane in the post-COVID era.

Abstract

Background: The optimal timing of tracheostomy in critically ill patients remains controversial. While early tracheostomy has been associated with reduced ventilator days and intensive care unit length of stay (LOS), survival benefits remain inconsistent. The coronavirus disease 2019 (COVID-19) pandemic changed intensive care unit workflows, airway management strategies, and interdisciplinary decision-making, potentially affecting tracheostomy practices even beyond the pandemic.

Aim: To evaluate differences in tracheostomy timing, interdisciplinary consultation patterns, and clinical outcomes before and after the COVID-19 pandemic in critically ill patients without active COVID-19.

Methods: This is a single-center retrospective cohort study of adult patients undergoing tracheostomy at a community hospital in New York during two periods, pre-COVID (October 2012 to February 2020) and post-COVID (June 2022 to July 2024). Patients with active COVID-19 were excluded. Demographics, comorbidities, time-based outcomes (including time to palliative care and surgical consultation, intubation-to-tracheostomy interval, and hospital LOS), and mortality at 2 months and 6 months were analyzed. Multivariable logistic regression was used to identify factors associated with 6-month mortality.

Results: A total of 314 patients were included (246 pre-COVID, 68 post-COVID). Compared with the pre-COVID cohort, post-COVID patients had a significantly shorter time to palliative care consultation (3 days vs 7 days, P = 0.001), surgical consultation (9.5 days vs 15.0 days, P < 0.001), intubation-to-tracheostomy interval (11.0 days vs 15.5 days, P < 0.001), and hospital LOS (29.5 days vs 34.0 days, P = 0.033). Mortality at 2 months and 6 months did not differ significantly between cohorts. In multivariable analyses, age was the only factor independently associated with mortality.

Conclusion: The post-COVID era was associated with earlier interdisciplinary engagement and tracheostomy placement without improvement in short- or long-term mortality. These findings suggest a pandemic-driven change in airway management practices. The COVID-19 pandemic may have sensitized healthcare providers, leading to earlier involvement in tracheostomy decision-making, but long-term effects are yet to be determined.