Epidemiology of Tracheostomy Among Adults with Acute Respiratory Failure and Mechanical Ventilation in the US – a Serial Cross-sectional Study of the National Inpatient Sample 2002-2014 Open Access

Abstract

Background

Acute respiratory failure (ARF) with mechanical ventilation (MV) and tracheostomy is associated with significant morbidity and mortality. Better understanding of this population is essential for improved patient selection and resource allocation. We describe epidemiology of patients with ARF and MV who received tracheostomy.

Methods

We used the Healthcare Cost and Utilization Project’s National Inpatient Sample (NIS) databases 2002-2014. We included patients ≥ 18 years old with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses of ARF (518.5, 518.51, 518.52, 518.53, 518.81, 518.82, 518.84), MV (96.70, 96.71, 96.72), and tracheostomy (31.1). We used the SAS 9.4 survey procedures to account for the complex multi-stage NIS sampling design to produce national estimates of tracheostomy procedure occurrence rates.

Results

During the study period, there were an estimated 860,699 ARF-MV discharges which also had procedure coding for tracheostomy. The annual incidence of tracheostomy increased from 21.2 to 29.9 cases per 100,000 adults from 2002 to 2010, followed by a plateau until 2014. There was no change in the annual incidence of tracheostomy per 1,000 ARF-MV cases. The annual proportion of patients 51-60 and 61-70 years old increased from 16.0% to 21.8%, and 20.8% to 25.1%, respectively, while the annual proportion of patients from 71-80 and ≥81 years old decreased from 26.2% to 18.9%, and 14.3% to 9.0%, respectively. The median index hospital length of stay decreased from 31.9 to 25.9 days, and in-hospital mortality decreased from 25.2% to 14.7%.

Conclusions

From 2002 to 2014, 9.2% of patients hospitalized with ARF-MV underwent tracheostomy. The incidence of tracheostomy increased and was likely driven by the rise in the underlying ARF-MV population. Decreasing trend was noted in median hospital LOS, in-hospital mortality, and in the proportion of patients with advanced age. These results suggest that outcomes are improving but further research is warranted to evaluate if these promising outcomes translate to tracheostomy patients in outside facilities.

Table of Contents

Introduction.. 1

Background.. 3

Aims. 5

Methods. 6

Study design and Database. 6

Participants. 7

Outcomes. 8

Incidence and number of cases. 8

Patient and hospital-level characteristics. 8

Demographics. 8

Elixhauser Comorbidity Measures. 9

Severity of Illness and Mortality Risk Subclasses. 10

Hospital variables. 10

Clinical Outcomes. 10

Analytic plan. 10

Incidence and number of cases. 12

Patient and hospital-level characteristics. 12

Clinical Variables. 12

Demographics. 12

Elixhauser Comorbidity Measures. 13

Severity of Illness and Mortality Risk Subclasses. 13

Hospital variables. 14

Clinical Outcomes. 14

References. 20

Figures and Tables. 23

Figure 1: Cohort Derivation. 23

Figure 2: Total No. of ARF-MV with Tracheostomy Cases from 2002-2014. 23

Figure 3: Incidence of Tracheostomy per 1,000 ARF-MV cases from 2002-2014. 24

Figure 4: Incidence of Tracheostomy per 1,000 Discharges from 2002-2014. 24

Figure 5: Incidence of Tracheostomy per 100,000 US Adults from 2002-2014. 25

Table 1: Patient Demographics of Tracheostomy Patients in 2002 and 2014. 26

Table 2: Clinical Variables of Tracheostomy Patients in 2002 and 2014. 27

Table 3: Hospital Variables of Tracheostomy Patients in 2002 and 2014. 28

Table 4: Clinical Outcomes of Tracheostomy Patients in 2002 and 2014. 29

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Statistics Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	respiratory failure tracheostomy mechanical ventilation
Committee Chair / Thesis Advisor	Kempker, Jordan, Emory University
Committee Members	Trammell, Aaron, Emory University Manatunga, Amita, Emory University

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