Patel Hetal H, Siltumens Aldis, Bess Leah, Camacho Fabian, Goldenberg David
Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA.
Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2015 Mar;152(3):465-9. doi: 10.1177/0194599814563513. Epub 2015 Jan 5.
To determine the trend of number of tracheotomies performed by otolaryngologists.
Case series with chart review.
Tertiary referral center in central Pennsylvania.
All patients undergoing tracheotomy between 2000 and 2013.
Data were gathered from billing records and operative reports to determine the service performing the tracheotomy. In addition, the surgical technique and indication for surgery were recorded. Negative binomial regressions were conducted to examine the number of tracheotomies performed by each specialty as a function of year.
In 2000, 44% of tracheotomies were being performed by the otolaryngology service, compared with only 25% in 2013. This is a decline of 22% over time. Since 2000, general surgery steadily increased the number of tracheotomies performed in comparison to the steady decrease performed by otolaryngology. Since 2008, general surgeons have significantly increased the number of percutaneous tracheotomies they perform (76% per year). Over the same period, the number of tracheotomies performed by the cardiothoracic surgery service has steadily increased by 26% per year. Most of the tracheotomies performed by cardiothoracic surgery are percutaneous tracheotomies.
This study illustrates that otolaryngologists at our institution are performing fewer tracheotomies over time. If this trend continues, the experience of our trainees may become diluted through reduction in surgical volume. While multi-institutional studies are warranted, this review provides a summary of data collected at a tertiary care institution, which may reflect national trends.
确定耳鼻喉科医生实施气管切开术的数量趋势。
病例系列研究并进行图表回顾。
宾夕法尼亚州中部的三级转诊中心。
2000年至2013年间所有接受气管切开术的患者。
从计费记录和手术报告中收集数据，以确定实施气管切开术的科室。此外，还记录了手术技术和手术指征。进行负二项回归分析，以检验各专科实施气管切开术的数量随年份的变化情况。
2000年，44%的气管切开术由耳鼻喉科实施，而2013年这一比例仅为25%。随着时间推移，这一比例下降了22%。自2000年以来，与耳鼻喉科气管切开术数量稳步下降相比，普通外科实施的气管切开术数量稳步增加。自2008年以来，普通外科医生实施的经皮气管切开术数量显著增加（每年增加76%）。同期，心胸外科实施的气管切开术数量每年稳步增加26%。心胸外科实施的大多数气管切开术是经皮气管切开术。
本研究表明，随着时间的推移，我们机构的耳鼻喉科医生实施的气管切开术数量越来越少。如果这种趋势持续下去，我们培训学员的经验可能会因手术量的减少而被稀释。虽然有必要进行多机构研究，但本综述总结了在一家三级医疗机构收集的数据，这可能反映了全国的趋势。
