Early tracheostomy in trauma patients saves time and money

Glendon A. Hyde, Stephanie A. Savage, Ben L. Zarzaur, Jensen E. Hart-Hyde, Candace B. Schaefer, Martin Croce, Timothy Fabian

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction Patients suffering traumatic brain and chest wall injuries are often difficult to liberate from the ventilator yet best timing of tracheostomy remains ill-defined. While prior studies have addressed early versus late tracheostomy, they generally suffer from the use of historical controls, which cannot account for variations in management over time. Propensity scoring can be utilized to identify controls from the same patient population, minimizing impact of confounding variables. The purpose of this study was to determine outcomes associated with early versus late tracheostomy by application of propensity scoring. Methods Patients requiring intubation within 48 h and receiving tracheostomy from January 2010 to June 2012 were identified. Early tracheostomy (ET) was a tracheostomy performed by the fifth hospital day. ET patients were matched to late tracheostomy patients (LT, tracheostomy after day 5) using propensity scoring and compared for multiple outcomes. Cost for services was calculated using average daily billing rates at our institution. Results One hundred and six patients were included, 53 each in the ET (mean day tracheostomy = 4) and the LT (mean day tracheostomy = 10) cohorts. The average age was 47 years and 94% suffered blunt injury, with an average NISS of 23.7. Patients in the ET group had significantly shorter TICU LOS (21.4 days vs. 28.6 days, p < 0.0001) and significantly fewer ventilator days (16.7 days vs. 21.9, p < 0.0001) compared to the LT group. ET patients also had significantly less VAP (34% vs. 64.2%, p = 0.0019). Conclusion In the current era of increased health-care costs, early tracheostomy significantly decreased both pulmonary morbidity and critical care resource utilization. This translates to an appreciable cost savings, at minimum $52,173 per patient and a potential total savings of $2.8 million/year for the entire LT cohort. For trauma patients requiring prolonged ventilator support, early tracheostomy should be performed.

Original languageEnglish (US)
Pages (from-to)110-114
Number of pages5
JournalInjury
Volume46
Issue number1
DOIs
StatePublished - Jan 1 2015

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Tracheostomy
Wounds and Injuries
Mechanical Ventilators
Time Management
Thoracic Injuries
Nonpenetrating Wounds
Confounding Factors (Epidemiology)
Cost Savings
Thoracic Wall
Critical Care
Intubation
Health Care Costs

All Science Journal Classification (ASJC) codes

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Hyde, G. A., Savage, S. A., Zarzaur, B. L., Hart-Hyde, J. E., Schaefer, C. B., Croce, M., & Fabian, T. (2015). Early tracheostomy in trauma patients saves time and money. Injury, 46(1), 110-114. https://doi.org/10.1016/j.injury.2014.08.049

Early tracheostomy in trauma patients saves time and money. / Hyde, Glendon A.; Savage, Stephanie A.; Zarzaur, Ben L.; Hart-Hyde, Jensen E.; Schaefer, Candace B.; Croce, Martin; Fabian, Timothy.

In: Injury, Vol. 46, No. 1, 01.01.2015, p. 110-114.

Research output: Contribution to journalArticle

Hyde, GA, Savage, SA, Zarzaur, BL, Hart-Hyde, JE, Schaefer, CB, Croce, M & Fabian, T 2015, 'Early tracheostomy in trauma patients saves time and money', Injury, vol. 46, no. 1, pp. 110-114. https://doi.org/10.1016/j.injury.2014.08.049
Hyde GA, Savage SA, Zarzaur BL, Hart-Hyde JE, Schaefer CB, Croce M et al. Early tracheostomy in trauma patients saves time and money. Injury. 2015 Jan 1;46(1):110-114. https://doi.org/10.1016/j.injury.2014.08.049
Hyde, Glendon A. ; Savage, Stephanie A. ; Zarzaur, Ben L. ; Hart-Hyde, Jensen E. ; Schaefer, Candace B. ; Croce, Martin ; Fabian, Timothy. / Early tracheostomy in trauma patients saves time and money. In: Injury. 2015 ; Vol. 46, No. 1. pp. 110-114.
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abstract = "Introduction Patients suffering traumatic brain and chest wall injuries are often difficult to liberate from the ventilator yet best timing of tracheostomy remains ill-defined. While prior studies have addressed early versus late tracheostomy, they generally suffer from the use of historical controls, which cannot account for variations in management over time. Propensity scoring can be utilized to identify controls from the same patient population, minimizing impact of confounding variables. The purpose of this study was to determine outcomes associated with early versus late tracheostomy by application of propensity scoring. Methods Patients requiring intubation within 48 h and receiving tracheostomy from January 2010 to June 2012 were identified. Early tracheostomy (ET) was a tracheostomy performed by the fifth hospital day. ET patients were matched to late tracheostomy patients (LT, tracheostomy after day 5) using propensity scoring and compared for multiple outcomes. Cost for services was calculated using average daily billing rates at our institution. Results One hundred and six patients were included, 53 each in the ET (mean day tracheostomy = 4) and the LT (mean day tracheostomy = 10) cohorts. The average age was 47 years and 94{\%} suffered blunt injury, with an average NISS of 23.7. Patients in the ET group had significantly shorter TICU LOS (21.4 days vs. 28.6 days, p < 0.0001) and significantly fewer ventilator days (16.7 days vs. 21.9, p < 0.0001) compared to the LT group. ET patients also had significantly less VAP (34{\%} vs. 64.2{\%}, p = 0.0019). Conclusion In the current era of increased health-care costs, early tracheostomy significantly decreased both pulmonary morbidity and critical care resource utilization. This translates to an appreciable cost savings, at minimum $52,173 per patient and a potential total savings of $2.8 million/year for the entire LT cohort. For trauma patients requiring prolonged ventilator support, early tracheostomy should be performed.",
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AU - Savage, Stephanie A.

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AU - Croce, Martin

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N2 - Introduction Patients suffering traumatic brain and chest wall injuries are often difficult to liberate from the ventilator yet best timing of tracheostomy remains ill-defined. While prior studies have addressed early versus late tracheostomy, they generally suffer from the use of historical controls, which cannot account for variations in management over time. Propensity scoring can be utilized to identify controls from the same patient population, minimizing impact of confounding variables. The purpose of this study was to determine outcomes associated with early versus late tracheostomy by application of propensity scoring. Methods Patients requiring intubation within 48 h and receiving tracheostomy from January 2010 to June 2012 were identified. Early tracheostomy (ET) was a tracheostomy performed by the fifth hospital day. ET patients were matched to late tracheostomy patients (LT, tracheostomy after day 5) using propensity scoring and compared for multiple outcomes. Cost for services was calculated using average daily billing rates at our institution. Results One hundred and six patients were included, 53 each in the ET (mean day tracheostomy = 4) and the LT (mean day tracheostomy = 10) cohorts. The average age was 47 years and 94% suffered blunt injury, with an average NISS of 23.7. Patients in the ET group had significantly shorter TICU LOS (21.4 days vs. 28.6 days, p < 0.0001) and significantly fewer ventilator days (16.7 days vs. 21.9, p < 0.0001) compared to the LT group. ET patients also had significantly less VAP (34% vs. 64.2%, p = 0.0019). Conclusion In the current era of increased health-care costs, early tracheostomy significantly decreased both pulmonary morbidity and critical care resource utilization. This translates to an appreciable cost savings, at minimum $52,173 per patient and a potential total savings of $2.8 million/year for the entire LT cohort. For trauma patients requiring prolonged ventilator support, early tracheostomy should be performed.

AB - Introduction Patients suffering traumatic brain and chest wall injuries are often difficult to liberate from the ventilator yet best timing of tracheostomy remains ill-defined. While prior studies have addressed early versus late tracheostomy, they generally suffer from the use of historical controls, which cannot account for variations in management over time. Propensity scoring can be utilized to identify controls from the same patient population, minimizing impact of confounding variables. The purpose of this study was to determine outcomes associated with early versus late tracheostomy by application of propensity scoring. Methods Patients requiring intubation within 48 h and receiving tracheostomy from January 2010 to June 2012 were identified. Early tracheostomy (ET) was a tracheostomy performed by the fifth hospital day. ET patients were matched to late tracheostomy patients (LT, tracheostomy after day 5) using propensity scoring and compared for multiple outcomes. Cost for services was calculated using average daily billing rates at our institution. Results One hundred and six patients were included, 53 each in the ET (mean day tracheostomy = 4) and the LT (mean day tracheostomy = 10) cohorts. The average age was 47 years and 94% suffered blunt injury, with an average NISS of 23.7. Patients in the ET group had significantly shorter TICU LOS (21.4 days vs. 28.6 days, p < 0.0001) and significantly fewer ventilator days (16.7 days vs. 21.9, p < 0.0001) compared to the LT group. ET patients also had significantly less VAP (34% vs. 64.2%, p = 0.0019). Conclusion In the current era of increased health-care costs, early tracheostomy significantly decreased both pulmonary morbidity and critical care resource utilization. This translates to an appreciable cost savings, at minimum $52,173 per patient and a potential total savings of $2.8 million/year for the entire LT cohort. For trauma patients requiring prolonged ventilator support, early tracheostomy should be performed.

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