Tracheostomy utilization for prolonged mechanical ventilation: A five-year descriptive study

Purpose: To identify outcome trends for patients in respiratory failure and patterns of practice in the performance of tracheostomies. Methods: Patients undergoing prolonged mechanical ventilation frequently undergo a trachcostomy to facilitate management. Diagnosis Related Group (DRG) 483 identifies patients undergoing a tracheostomy for respiratory failure. Discharge data were requested from the New York Statewide Planning and Research Cooperative System (SPARCS) for the years 1992 to 1996, (n=34701). Data includes all patients 18 years and older for the acute care hospitals in New York State for the period. Results: The population of tracheostomized patients for respiratory failure increased steadily in the study period (5619 patients in 1992 vs. 8734 in 1996, a 35% relative increase). A decrease in mortality is seen over the five year period for the total population of patients (54%, 52.2%, 47.3%, 46.8%, 45% in 1996) Most of the patients have the tracheostomy performed between day 7 and 20 after the onset of respiratory failure (58%). Conclusions: A more aggressive use of the tracheostomy as a therapeutic maneuver is seen over time, as evidenced by the increased use of this DRG. A decrease in mortality over the period is evident as well. A majority of the patients underwent a trachcostomy between the second and third week of respiratory failure. Clinical Implications: Both an improvement in final outcome for patients in respiratory failure who require tracheostomy and an increase in the use of this therapeutic maneuver are evident. A possible explanation is a change in physician behavior, broadening the indications for the procedure. Although controversial, over a five-year period, the timing of the procedure was homogeneous and uniform.