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Sex, race, insurance type affect time to early tracheostomy care

Researchers identified several factors that appeared to affect the time from intubation to tracheostomy among ventilator-dependent patients, according to study results.

Univariate and multivariate analysis showed women, Medicaid recipients, and patients who were black or Hispanic were less likely to receive early tracheostomy.

Joshua J. Shaw, MD, of the department of surgery and the Center for Outcomes Research-Surgical Research Scholars Program at University of Massachusetts Medical School, and colleagues used the University HealthSystem Consortium to identify 49,191 patients who underwent a tracheostomy after initial intubation between 2007 and 2010.

The researchers defined an early tracheostomy as occurring less than 7 days after initial intubation, and a late tracheostomy as occurring more than 10 days after.

Shaw and colleagues identified 29,029 patients who underwent an early tracheostomy and 28,162 patients who underwent a late tracheostomy. Those in the early tracheostomy group were more likely to be younger (mean age, 58 years vs. 60 years), men (63% vs. 57%), white (63% vs. 55%) and have private insurance (35% vs. 26%).

Patients who received early tracheostomy demonstrated a reduced mortality risk (OR = 0.84; 95% CI, 0.79–0.88). Patients in the early tracheostomy group also had shorter ICU lengths of stay (16 days vs. 27 days, P < .0001) and shorter hospital lengths of stay (25 days vs. 38 days; P < .0001). This translated into lower total direct cost ($61,163 vs. $97,292; P < .0001) and lower total charges ($251,333 vs. $400,061; P < .0001) among patients who underwent early tracheostomy.

Results showed women (OR = 0.84; 95% CI, 0.81-0.87), patients who were black (OR = 0.85; 95% CI, 0.81-0.9) or Hispanic (OR = 0.85; 95% CI, 0.78-0.92), those on Medicaid (OR = 0.95; 95% CI, 0.89-0.99), uninsured patients (OR = 0.86; 95% CI, 0.83-0.9) and patients admitted with a non-trauma diagnosis were significantly less likely to receive early tracheostomy.

“The benefits of tracheostomy, including shorter ICU and hospital length of stay, lower costs and improved in-hospital mortality, are greatest when tracheostomy is performed early in the course of mechanical ventilation,” Shaw and colleagues wrote. “Yet, there are notable sociodemographic disparities in receipt of early tracheostomy even after controlling for a number of clinical factors.

“Further research is needed to determine why women, certain minorities and those with Medicaid are less likely to receive an early tracheostomy,” they wrote. “Standardized protocols to determine the timing of tracheostomy for mechanically ventilated patients may help to correct these disparities.” – by Jeff Craven

Disclosure: The researchers report no relevant financial disclosures.