Financial Implications of Early Tracheostomy in the Healthcare Cost Containment Era

Abstract

ABSTRACT Background Tracheostomy is often performed for critically ill patients who are anticipated to have a prolonged intensive care unit (ICU) stay, in order to prevent the complications of endotracheal intubation. The timing of a tracheostomy has been much studied over the past 40 years with many analyses differing in methodology, patient population and outcomes. The purpose of this study was to investigate if early tracheostomy (≤7 days) in critically ill trauma patients increase ventilator and ICU-free days, reduce hospital days and decrease hospital costs. Materials and methods Trauma patients admitted to a level 1 Trauma Center requiring tracheostomy (2006.2013) were retrospectively identified. Patients receiving early tracheostomy (≤7 days) were compared to late tracheostomy (>7 days) for demographics, clinical data and outcomes. Dichotomous variables were compared by Chi-square or Fisher's exact tests, where appropriate, and continuous variables were compared using Student's t or Mann-Whitney U tests. Results Five hundred and twenty-nine patients required a tracheostomy during the study period [292 (55.2%) early and 237 (44.8%) late]. Patients requiring early tracheostomy were more often male (80.5 vs 70.5%, p = 0.007) and younger (41.5 ± 18.6 years vs 50.5 ± 21.2 years, p < 0.001). There were no differences in injury severity scores (ISS 28.4 ± 12.5 vs 27.2 ± 11.1, p = 0.161) but early tracheostomy patients were more likely to sustain severe traumatic brain injury (81.2 vs 65.0%, p < 0.001). There were no differences in transfusion requirements or need for intracavitary procedures. When outcomes were analyzed, while there was no difference in mortality (8.9 vs 5.1%, adjusted p = 0.126), early tracheostomy patients had significantly shorter ventilator days (8.7 ± 7.2 days vs 19.0 ± 10.4 days, adjusted p < 0.001), hospital days (22.3 ± 17.9 days vs 30.0 ± 18.4 days, adjusted p < 0.001) and ICU days (11.6 ± 8.4 days vs 22.8 ± 11.6 days, adjusted p < 0.001). In addition, ventilator-associated pneumonia rates were lower among early tracheostomy patients (8.6 vs 17.7%, adjusted p = 0.002). Hospital costs were unsurprisingly less in early tracheostomy patients ($ 55,371 ± 36,280 vs $ 93,702 ± 51,427, adjusted p < 0.001). Conclusion In critically, ill trauma patients, early tracheostomy was associated with shorter duration of mechanical ventilation, ICU and hospital days, and lower ventilation associated pneumonia rates. In addition, total hospital costs were significantly decreased in the early tracheostomy group. In this cohort alone, early tracheostomy would have resulted in a potential hospital cost saving of 2.5 million/year. How to cite this article Branco B, De Vitis J, Joseph B, Kulvatunyou N, Tang A, Friese RS, Rhee P, O'Keeffe T. Financial Implications of Early Tracheostomy in the Healthcare Cost Containment Era. Panam J Trauma Crit Care Emerg Surg 2015;4(3):194-201.