Mortality after Tracheostomy at a Tertiary Care Hospital

Abstract

Objective: Hospitals are increasingly being evaluated for postoperative mortality, which includes intensive care patients who succumb to their medical disease after routine tracheostomy. Here we evaluate the expediency of tracheostomy performance and perioperative mortality over a 6-month period.

Method: Prospective analysis of medical intensive care patients who underwent tracheostomy placement over a 6-month period at a tertiary care hospital. Variables evaluated were time to tracheostomy, time to death, and cause of death.

Results: There were 76 consultations that resulted in 64 patients receiving tracheostomy. Four (5.3%) patients expired the day prior to or the day of planned tracheostomy. Six (7.9%) were extubated prior to tracheostomy. Many were performed within 24 hours from consultation time (37%), and some were performed on the same day as consultation (9.3%). The overall 30-day postoperative mortality rate was 11%. Cause of death in all cases was due to pre-existing conditions and not related to tracheostomy. Thirty-six (57%) survived to discharge. The mean time from consultation to tracheostomy was 2.5 days (range 0 -12).

Conclusion: High rates of mortality after tracheostomy negatively impact hospital postoperative mortality and hospital ratings. Although there were no surgical deaths, only 57% of tracheostomy patients survived to discharge, illustrating the significant disease burden in this patient population and the need to stratify postoperative mortality.