Abstract
Objectives:
Comparing management of tracheotomies in older (>75 years old) versus younger patients ≤75 years old) for duration of hospitalization secondary to tracheotomy and finding associated risk factors.
Methods:
Retrospective chart review (2003-2013) for all patients >75 years old who had tracheotomy compared to patients ≤75 years old.
Results:
Mean age is 79.3 versus 53.1 years, respectively (P < .0001). Main reason for tracheotomy is prolonged endotracheal intubation (59/112-52.7% vs 65/99-65.7%, P = .181). There is a statistically significant difference between time performing tracheotomy and its weaning for older versus younger patients: 33.14 (24.41-41.87 confidence interval [CI] 95%) versus 22.90 days (19.22-26.59 CI 95%, < .0285). Older patients stayed 4.73 days longer at hospital specifically for tracheotomy management (1.97-41.87, CI 95%) versus 0.58 days for younger patients (0.00-1.42 CI 95%, P < .0001). When leaving hospital with a tracheotomy, discharge is delayed by 14.39 days in older (5.80-22.98 CI 95%) versus 3.17 days in younger patients (0.00-8.02 CI 95%, P = .0299). Elderly patients are discharged to a nursing home more frequently (36.5% vs 20.7%, P = .0255). Spearman correlation revealed that time between tracheotomy and the first change of cannula, time to wean tracheotomy and postoperative Eastern Cooperative Oncology Group status were all predictive factors of prolonged hospitalization (all P < .0001).
Conclusion:
Elderly patients need special management secondary to a tracheotomy to prevent prolonged hospitalization. Improving doctor awareness and knowledge of patient risk factors may improve tracheotomy management.
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