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    Who Gets Early Tracheostomy?: Evidence of Unequal Treatment at 185 Academic Medical Centers

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    Authors
    Shaw, Joshua J.
    Santry, Heena
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Center for Outcomes Research-Surgical Research Scholars Program
    Department of Surgery
    Document Type
    Journal Article
    Publication Date
    2015-11-01
    Keywords
    *Academic Medical Centers
    Critical Illness
    Female
    Humans
    Intensive Care Units
    Length of Stay
    Male
    Middle Aged
    Respiration, Artificial
    Retrospective Studies
    Time Factors
    Tracheostomy
    United States
    UMCCTS funding
    Health Services Administration
    Otolaryngology
    Surgery
    Surgical Procedures, Operative
    Translational Medical Research
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    Link to Full Text
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631039/
    Abstract
    BACKGROUND: Although the benefits of early tracheostomy in patients dependent on ventilators are well established, the reasons for variation in time from intubation to tracheostomy remain unclear. We identified clinical and demographic disparities in time to tracheostomy. METHODS: We performed a level 3 retrospective prognostic study by querying the University HealthSystem Consortium (2007-2010) for adult patients receiving a tracheostomy after initial intubation. Time to tracheostomy was designated early ( < 7 days) or late ( > 10 days). Cohorts were stratified by time to tracheostomy and compared using univariate tests of association and multivariable adjusted models. RESULTS: A total of 49,191 patients underwent tracheostomy after initial intubation: 42% early (n = 21,029) and 58% late (n = 28,162). On both univariate and multivariable analyses, women, blacks, Hispanics, and patients receiving Medicaid were less likely to receive an early tracheostomy. Patients in the early group also experienced lower rates of mortality (OR, 0.84; 95% CI, 0.79-0.88). CONCLUSIONS: Early tracheostomy was associated with increased survival. Yet, there were still significant disparities in time to tracheostomy according to sex, race, and type of insurance. Application of evidence-based algorithms for tracheostomy may reduce unequal treatment and improve overall mortality rates. Additional research into this apparent bias in referral/rendering of tracheostomy is needed.
    Source

    Chest. 2015 Nov;148(5):1242-50. doi: 10.1378/chest.15-0576. Link to article on publisher's site

    DOI
    10.1378/chest.15-0576
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/50496
    PubMed ID
    26313324
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    ae974a485f413a2113503eed53cd6c53
    10.1378/chest.15-0576
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