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Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993-2002.

Publication ,  Journal Article
Cox, CE; Carson, SS; Holmes, GM; Howard, A; Carey, TS
Published in: Crit Care Med
November 2004

OBJECTIVE: Patients who require tracheostomy for prolonged mechanical ventilation have poor outcomes and high costs of care. However, recent longitudinal trends relevant to these patients and their care have not been described. We aimed to describe trends in the annual incidence and timing of tracheostomy for prolonged mechanical ventilation, as well as prolonged mechanical ventilation patient resource utilization and overall in-hospital mortality. DESIGN AND SETTING: Retrospective review of the North Carolina Hospital Discharge Database, a comprehensive record of all state nonfederal, nonpsychiatric hospital discharges between 1993 and 2002. PATIENTS: Patients were 9,794 medical and surgical patients >/=18 yrs of age with International Classification of Diseases, Ninth Revision, Clinical Modification code 96.72 (mechanical ventilation for >96 hrs) and Diagnosis Related Group code 483 (tracheostomy except for face, neck, and mouth diagnoses). INTERVENTIONS: None. MEASUREMENTS: Incidence rates adjusted for annual population growth, mechanical ventilation days until tracheostomy placement, length of stay, and hospital charges and payments adjusted by the medical component of the Consumer Price Index. MAIN RESULTS: Between 1993 and 2002, the incidence of tracheostomy for prolonged mechanical ventilation increased across all age groups from 8.3 of 100,000 to 24.2 of 100,000 (p < .001), although most significantly among patients <55 yrs of age. During this period, a decrease was seen in mortality (from 39% to 25%), median mechanical ventilation days to tracheostomy placement (from 12 to 10 days), and median length of stay (from 47 to 33 days). By 2002, patients were almost three times less likely to be discharged to home independently although twice as likely to be sent to a skilled nursing facility. Although prolonged mechanical ventilation patients with tracheostomies represented only 7% of all who required mechanical ventilation, their total charges during the study period were 1.74 billion dollars-22% of all mechanical ventilation patient charges. CONCLUSION: The incidence of tracheostomy for prolonged mechanical ventilation increased by nearly 200% during the past decade in North Carolina, exceeding changes in the overall incidence of respiratory failure three-fold. Although in-hospital mortality, length of stay, and charges per patient fell over time, the overall resource utilization of prolonged mechanical ventilation patients increased dramatically.

Duke Scholars

Published In

Crit Care Med

DOI

ISSN

0090-3493

Publication Date

November 2004

Volume

32

Issue

11

Start / End Page

2219 / 2226

Location

United States

Related Subject Headings

  • Tracheostomy
  • Time Factors
  • Retrospective Studies
  • Respiration, Artificial
  • Practice Patterns, Physicians'
  • Patient Discharge
  • Outcome and Process Assessment, Health Care
  • North Carolina
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Cox, C. E., Carson, S. S., Holmes, G. M., Howard, A., & Carey, T. S. (2004). Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993-2002. Crit Care Med, 32(11), 2219–2226. https://doi.org/10.1097/01.ccm.0000145232.46143.40
Cox, Christopher E., Shannon S. Carson, George M. Holmes, Ann Howard, and Timothy S. Carey. “Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993-2002.Crit Care Med 32, no. 11 (November 2004): 2219–26. https://doi.org/10.1097/01.ccm.0000145232.46143.40.
Cox CE, Carson SS, Holmes GM, Howard A, Carey TS. Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993-2002. Crit Care Med. 2004 Nov;32(11):2219–26.
Cox, Christopher E., et al. “Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993-2002.Crit Care Med, vol. 32, no. 11, Nov. 2004, pp. 2219–26. Pubmed, doi:10.1097/01.ccm.0000145232.46143.40.
Cox CE, Carson SS, Holmes GM, Howard A, Carey TS. Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993-2002. Crit Care Med. 2004 Nov;32(11):2219–2226.

Published In

Crit Care Med

DOI

ISSN

0090-3493

Publication Date

November 2004

Volume

32

Issue

11

Start / End Page

2219 / 2226

Location

United States

Related Subject Headings

  • Tracheostomy
  • Time Factors
  • Retrospective Studies
  • Respiration, Artificial
  • Practice Patterns, Physicians'
  • Patient Discharge
  • Outcome and Process Assessment, Health Care
  • North Carolina
  • Middle Aged
  • Male