Predictive factors for patient outcomes following open bedside tracheotomy

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Abstract
Objectives/Hypothesis: Open bedside tracheotomy (OBT) in the intensive care unit (ICU) has been advocated as a safe and more cost-effective alternative to tracheotomy performed in the operating room. The objective of this study is to determine predictive factors for postoperative outcomes, including decannulation and in-hospital mortality following OBT. Study Design: Retrospective chart review. Methods: The charts of 330 consecutive adult patients who underwent OBT at a tertiary care medical center between January, 2005, and April, 2011, were reviewed. Perioperative variables including demographics, comorbidities, serological markers, and time to tracheotomy were collected and analyzed in relation to the endpoints of in-hospital mortality and decannulation rate. Results: A total of 218 patients were included in the final analysis. The decannulation rate was 26.1% and inpatient mortality was 24.2%. On multivariate analysis, the inpatient mortality rate was significantly increased and the decannulation rate was significantly decreased among patients with concomitant cardiac or respiratory disease, or a coincident diagnosis of malignancy. ICU length of stay was increased by 4.5 days for each unit increase in cardiac comorbidity count. Conclusions: Admitting diagnosis and serological markers did not predict the rates of decannulation or in-hospital mortality. However, the presence of cardiac disease and/or oncologic comorbidities played a significant role in predicting hospital mortality or eventual decannulation. Several comorbidity combinations resulted in a greater than 60% likelihood of inpatient mortality. In this population, the overall benefit of an OBT may be debatable. Despite very high overall acuity levels, there were no serious procedural complications, indicating that bedside tracheotomy is safe in ill patients.

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