Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.
Finance Department, Oslo University Hospital, Oslo, Norway.
Ear Nose Throat J. 2023 Aug;102(8):516-521. doi: 10.1177/01455613211018578. Epub 2021 May 19.
Open surgical tracheostomy (OST) is a common procedure performed on intensive care unit (ICU) patients. The procedure can be performed bedside in the ICU (bedside open surgical tracheostomy, BeOST) or in the operating room (operating room open surgical tracheostomy, OROST), with comparable safety and long-term complication rates. We aimed to perform a cost analysis and evaluate the use of human resources and the total time used for both BeOSTs and OROSTs.
All OSTs performed in 2017 at 5 different ICUs at Oslo University Hospital Ullevål were retrospectively evaluated. The salaries of the personnel involved in the 2 procedures were obtained from the hospital's finance department. The time taken and the number of procedures performed were extracted from annual reports and from the electronic patient record system, and the annual expenditures were calculated.
Altogether, 142 OSTs were performed, of which 122 (86%) and 20 (14%) were BeOSTs and OROSTs, respectively. A BeOST cost 343 EUR (95% CI: 241.4-444.6) less than an OROST. Bedside open surgical tracheostomies resulted in an annual cost efficiency of 41.818 EUR. In addition, BeOSTs freed 279 hours of operating room occupancy during the study year. Choosing BeOST instead of OROST made 1 nurse, 2 surgical nurses, and 1 anesthetic nurse redundant.
Bedside open surgical tracheostomy appears to be cost-, time-, and resource-effective than OROST. In the absence of contraindications, BeOSTs should be performed in ICU patients whenever possible.
开放式外科气管切开术（OST）是在重症监护病房（ICU）中对患者进行的常见手术。该手术可以在 ICU 床边进行（床边开放式外科气管切开术，BeOST）或在手术室进行（手术室开放式外科气管切开术，OROST），其安全性和长期并发症发生率相当。我们旨在进行成本分析，并评估两种方法（BeOST 和 OROST）在使用人力资源和总时间方面的情况。
回顾性评估了 2017 年在奥斯陆大学医院 Ullevål 的 5 个不同 ICU 进行的所有 OST。涉及两种手术的人员工资从医院财务部获得。从年度报告和电子患者记录系统中提取所用时间和手术次数，并计算年度支出。
总共进行了 142 例 OST，其中 122 例（86%）为 BeOST，20 例（14%）为 OROST。BeOST 比 OROST 便宜 343 欧元（95%CI：241.4-444.6）。床边开放式外科气管切开术每年的成本效益为 41818 欧元。此外，BeOST 在研究年内释放了 279 个手术室占用时间。选择 BeOST 而不是 OROST，使 1 名护士、2 名外科护士和 1 名麻醉护士冗余。
床边开放式外科气管切开术在成本、时间和资源方面似乎优于 OROST。在没有禁忌症的情况下，应尽可能在 ICU 患者中进行 BeOST。
