Timing and Outcomes of Tracheostomy Performed by Pulmonary and/or Critical Care Physicians.
Autor: Nishi, Shawn P. E.; Shah, Shiwan K.; Zhang, Wei; Kuo, Yong-Fang; Sharma, Gulshan
Publication year: 2020
Journal of intensive care medicine
issn:1525-1489 0885-0666
doi: 10.1177/0885066618770380
Abstract:
BACKGROUND: Although pulmonary and/or critical care (P/CC) physicians perform percutaneous tracheostomy in mechanically ventilated patients, the trends, timing, and outcomes of this procedure have not been well described. This study aims to describe the trends, timing, and outcomes of this procedure. METHODS: Using 5% medicare data, we retrospectively examined a cohort who had tracheostomy performed after initiation of mechanical ventilation during acute hospitalization to describe the timing of tracheostomy placement by pulmonary and/or critical care (P/CC) physicians and associated outcomes. RESULTS: There were 4864 participants in the study cohort from 2007 to 2014. We examined the timing of tracheostomy (in days from initiation of mechanical ventilation), length of hospital stay, in-hospital death, and death within 30 days after hospital discharge. The percentage of tracheostomies performed by P/CC physicians increased significantly, from 7.2% in 2007 to 14.1% in 2014 (Cochran-Armitage test for trend, P = .001). Tracheostomies performed by P/CC physicians were more common in larger hospitals and major academic medical centers. After adjustment for baseline characteristics, the following parameters did not differ by provider: time to tracheostomy, length of hospital stay (days), in-hospital death, and death within 30 days after discharge. A tracheostomy was more likely to be performed by a P/CC physician at a larger (≥500 beds) hospital (adjusted odds ratio: 1.85, 95% confidence interval: 1.47-2.34). CONCLUSIONS: Tracheostomies are increasingly performed by P/CC physicians with similar outcomes, likely related to patient selection.
Language: eng
Rights:
Pmid: 29683054
Tags: Humans; Aged; Aged, 80 and over; Female; Male; Retrospective Studies; United States; Practice Patterns, Physicians’/*statistics & numerical data; Critical Care Outcomes; Medicare; *Time Factors; Critical Care/methods/*statistics & numerical data; interventional pulmonary; mechanical ventilation; medicare; P/CC physicians; Physicians/*statistics & numerical data; Pulmonologists/statistics & numerical data; Respiration, Artificial/methods/statistics & numerical data; tracheostomy; Tracheostomy/methods/*statistics & numerical data
Link: https://pubmed.ncbi.nlm.nih.gov/29683054/
