Who Gets Early Tracheostomy?: Evidence of Unequal Treatment at 185 Academic Medical Centers
AuthorsShaw, Joshua J.
UMass Chan AffiliationsDepartment of Quantitative Health Sciences
Center for Outcomes Research-Surgical Research Scholars Program
Department of Surgery
Document TypeJournal Article
Keywords*Academic Medical Centers
Intensive Care Units
Length of Stay
Health Services Administration
Surgical Procedures, Operative
Translational Medical Research
MetadataShow full item record
AbstractBACKGROUND: 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.
Chest. 2015 Nov;148(5):1242-50. doi: 10.1378/chest.15-0576. Link to article on publisher's site
Permanent Link to this Itemhttp://hdl.handle.net/20.500.14038/50496