Dvorak Justin, Ridder David, Martin Brendan, Ton-That Hieu, Baldea Anthony, Gonzalez Richard P
Am Surg. 2019 May 1;85(5):518-523.
The aim of the study was to determine the frequency of surgical patients who undergo tracheostomy and gastrostomy insertion during the same hospitalization. Secondary outcomes included ICU and hospital length of stay (LOS) for patients who underwent concomitant tracheostomy and gastrostomy those who did not. This study is a retrospective review of trauma and acute care surgery (ACS) patients between 2006 and 2015 who underwent tracheostomy. Patients who also underwent open gastrostomy or percutaneous endoscopic gastrostomy during the same hospitalization were identified. Data collected included patient demographics, hospital LOS, ICU LOS, and timing of tracheostomy and gastrostomy. Three hundred one trauma and ACS patients who underwent tracheostomy were identified. Seventy- three per cent of tracheostomy patients underwent gastrostomy during the same admission. Of patients who had both tubes inserted, 79 per cent (175) underwent gastrostomy with tracheostomy as the concomitant procedure, whereas 21 per cent received gastrostomy as a delayed procedure. Median hospital LOS for patients who underwent concomitant procedures was 25 days 22 days for those who had delayed or no gastrostomy ( = 0.24). Eighty-four per cent of patients who had tracheostomy for prolonged or anticipated prolonged mechanical ventilation were receiving tube feeds at discharge, and 78 per cent had not been advanced to an oral diet at discharge. Most trauma/ACS patients who undergo tracheostomy also undergo gastrostomy during their hospitalization. Concomitant gastrostomy is not associated with a decrease in hospital LOS; however, most patients who undergo tracheostomy for prolonged mechanical ventilation are discharged receiving enteral nutrition. These patients may benefit from concomitant ICU gastrostomy as a way to improve efficiency and cost-saving.
本研究的目的是确定在同一住院期间接受气管切开术和胃造口术的手术患者的频率。次要结果包括接受同期气管切开术和胃造口术的患者与未接受的患者的重症监护病房（ICU）住院时间和医院住院时间（LOS）。本研究是对2006年至2015年间接受气管切开术的创伤和急性护理手术（ACS）患者的回顾性研究。确定了在同一住院期间还接受了开放式胃造口术或经皮内镜下胃造口术的患者。收集的数据包括患者人口统计学、医院住院时间、ICU住院时间以及气管切开术和胃造口术的时间。共确定了301例接受气管切开术的创伤和ACS患者。73%的气管切开术患者在同一住院期间接受了胃造口术。在同时插入两根导管的患者中，79%（175例）在进行气管切开术的同时接受了胃造口术，而21%的患者接受了延迟胃造口术。接受同期手术的患者的中位医院住院时间为25天，而接受延迟或未接受胃造口术的患者为22天（P = 0.24）。因长期或预期长期机械通气而接受气管切开术的患者中，84%在出院时接受管饲，78%在出院时未恢复经口饮食。大多数接受气管切开术的创伤/ACS患者在住院期间也接受胃造口术。同期胃造口术与医院住院时间的减少无关；然而，大多数因长期机械通气而接受气管切开术的患者出院时接受肠内营养。这些患者可能受益于同期ICU胃造口术，作为提高效率和节省成本的一种方式。
