The Impact of Tracheostomy Indication on Patient Outcomes and Hospital Course

Objective

The purpose of this study is to better understand the prognostic implications for a patient's hospital course, chances for ventilator liberation and decannulation, functional status, and mortality based on the indication for tracheostomy.

Methods

A retrospective analysis was performed at a single tertiary-care institution for 106 adult patients who underwent a tracheostomy from January 2022 to March 2023 and were followed for 6 months post-tracheostomy placement. Demographics, clinical intervals, and clinical outcomes were compared based on the indication for tracheostomy: Airway Obstruction or Ventilator-Dependent Respiratory Failure (VDRF).

Results

In the study group, 29 patients received a tracheostomy for airway obstruction, and 77 patients received a tracheostomy for VDRF. The VDRF group had more than three times longer hospital stays, more than three times the duration from first intubation to tracheostomy placement, six times the duration of mechanical ventilation post-tracheostomy, and increased rates of hospital mortality (23.4% vs. 3.4%) and mortality at 6 months post-tracheostomy placement (42.4% vs. 10.5%) compared to the Airway Obstruction group (p's < 0.05). The VDRF group was less likely to be discharged home (6.5% vs. 44.8%). At discharge, the majority of patients were liberated from mechanical ventilation (82.8%) and speaking (77.0%). Most surviving patients were not decannulated during their admission (65.5%). There were no significant differences in diet or time interval to decannulation.

Conclusion

Our analysis suggests that consideration of clinical indicators pertaining to tracheostomy placement may facilitate improved conversations with patients, families, and healthcare teams regarding the nuances of the functional and logistical course after receiving a tracheostomy.

Level of Evidence

3.