Yang Anthony, Gray Mingyang L, McKee Sean, Kidwai Sarah M, Doucette John, Sobotka Stanislaw, Yao Mike, Iloreta Alfred
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
Laryngoscope. 2018 Dec;128(12):2844-2851. doi: 10.1002/lary.27334. Epub 2018 Oct 3.
OBJECTIVES/HYPOTHESIS: The purpose of this study was to compare timing of procedure, patient characteristics, outcomes, and charges for patients who underwent percutaneous versus surgical tracheostomy.
Retrospective cohort study.
A retrospective analysis was performed for all patients who underwent tracheostomy in 2015 to 2016 in New York State. Patients were identified using International Classification of Diseases, 10th Revision, Clinical Modification codes and stratified to the type of tracheostomy performed. The primary outcome of interest was mortality at index stay. Secondary outcomes of interest included length of stay and total hospitalization charges.
Of the 8,682 patients, 2,488 (28.7%) underwent percutaneous and 6,194 (71.3%) underwent surgical tracheostomy. At hospitals where both procedures were performed, percutaneous tracheostomy patients were older, had more comorbidities, and had lower income (P < .05). Timing of the tracheostomy relative to admission did not affect the type of tracheostomy performed. While controlling for patient characteristics and complications during the visit, percutaneous tracheostomy was associated with increased mortality (odds ratio [OR]: 1.17, 95% confidence interval [CI]: 1.03-1.33, P = .0153) and increased hospital charges (OR: + 7.76%, 95% CI: 5.4-10.11, P < .0001). Length of stay was not affected by procedure type.
Surgical tracheostomies are more commonly performed than percutaneous tracheostomies across New York State. Older, lower-income, and sicker patients have a higher chance of receiving percutaneous tracheostomies. Percutaneous approaches were associated with statistically significant increased mortality and higher charges despite no difference in length of stay. Further studies are needed to determine if these differences in outcomes are clinically significant.
NA Laryngoscope, 128:2844-2851, 2018.
目的/假设：本研究旨在比较接受经皮气管切开术与外科气管切开术患者的手术时机、患者特征、结局及费用。
回顾性队列研究。
对2015年至2016年在纽约州接受气管切开术的所有患者进行回顾性分析。使用国际疾病分类第10版临床修订本编码识别患者，并根据所施行的气管切开术类型进行分层。感兴趣的主要结局是首次住院期间的死亡率。感兴趣的次要结局包括住院时间和总住院费用。
在8682例患者中，2488例（28.7%）接受了经皮气管切开术，6194例（71.3%）接受了外科气管切开术。在同时施行这两种手术的医院中，经皮气管切开术患者年龄更大，合并症更多，收入更低（P＜0.05）。气管切开术相对于入院的时机并不影响所施行的气管切开术类型。在控制患者特征和就诊期间的并发症后，经皮气管切开术与死亡率增加相关（优势比[OR]：1.17，95%置信区间[CI]：1.03 - 1.33，P = 0.0153），且与住院费用增加相关（OR：+7.76%，95% CI：5.4 - 10.11，P＜0.0001）。住院时间不受手术类型的影响。
在纽约州，外科气管切开术的施行比经皮气管切开术更常见。年龄较大、收入较低且病情较重的患者接受经皮气管切开术的机会更高。尽管住院时间没有差异，但经皮手术方式与死亡率显著增加和费用更高相关。需要进一步研究以确定这些结局差异是否具有临床意义。
NA 《喉镜》，128:2844 - 2851，2018年。
