TY - JOUR
T1 - A prospective, randomized study comparing percutaneous with surgical tracheostomy in critically ill patients
AU - Freeman, Bradley D.
AU - Isabella, Karen
AU - Perren Cobb, J.
AU - Boyle, Walter A.
AU - Schmieg, Robert E.
AU - Kolleff, Marin H.
AU - Lin, Natatia
AU - Saak, Thomas
AU - Thompson, Errington C.
AU - Buchman, Timothy G.
N1 - Funding Information:
Supported, in part, by a grant from the Barnes Jewish Hospital Innovations in Health Care Program and GM00691-01 .
PY - 2001
Y1 - 2001
N2 - Objective: To determine the relative cost-effectiveness of percutaneous dilational tracheostomy (PDT) and surgical tracheostomy (ST) in critically ill patients. Design: Prospective randomized study. Setting: Medical, surgical, and coronary intensive care units at Barnes-Jewish Hospital, a tertiary care medical center. Patients: Eighty critically ill mechanically ventilated patients requiring elective tracheostomy. Interventions: Randomization to either PDT performed in the intensive care unit or ST performed in the operating room. Measurements and Main Results: Treatment groups were well matched with respect to age (PDT, 65.44 ± 2.82 [mean ± SE] years; ST, 61.4 ± 2.89 years, p = Ns), gender (PDT, 45% males; ST, 47.5% males, p = NS), severity of illness (Acute Physiology and Chronic Health Evaluation II score: PDT, 16.87 ± 0.84; ST, 17.88 ± 0.92, p = NS), and principle diagnosis. PDT was performed more quickly (PDT, 20.1 ± 2.0 mins; ST, 41.7 ± 3.9 mins, p < .0001) and was associated with lower patient charges than ST (total patient charges: PDT, $1,569 ± $157 vs. ST, $3,172 ± $114; equipment/supply charges: PDT, $688 ± $103 vs. ST, $1,526 ± $87; professional charges: PDT, $880 ± $ 54 vs. ST, $1,647 ± $50; p < .0001 for all). There were no differences in days intubated before tracheostomy (PDT, 12.7 ± 1.1 days; ST, 15.6 ± 1.9, p = .20), intensive care unit length of stay (PDT, 24.5 ± 2.5 days; ST, 28.5 ± 3.1 days, p = .33), or hospital length of stay (PDT 49.7 ± 4.2 days; ST, 43.7 ± 3.5 days, p = .28) when we compared these two techniques. Conclusions: PDT is a cost-effective alternative to ST. The reduction in patient charges associated with PDT in this study resulted from the procedure being performed in the intensive care unit, thus eliminating the need for operating room facilities and personnel. PDT may become the procedure of choice for electively establishing tracheostomy in the appropriately selected patient who requires long-term mechanical ventilation.
AB - Objective: To determine the relative cost-effectiveness of percutaneous dilational tracheostomy (PDT) and surgical tracheostomy (ST) in critically ill patients. Design: Prospective randomized study. Setting: Medical, surgical, and coronary intensive care units at Barnes-Jewish Hospital, a tertiary care medical center. Patients: Eighty critically ill mechanically ventilated patients requiring elective tracheostomy. Interventions: Randomization to either PDT performed in the intensive care unit or ST performed in the operating room. Measurements and Main Results: Treatment groups were well matched with respect to age (PDT, 65.44 ± 2.82 [mean ± SE] years; ST, 61.4 ± 2.89 years, p = Ns), gender (PDT, 45% males; ST, 47.5% males, p = NS), severity of illness (Acute Physiology and Chronic Health Evaluation II score: PDT, 16.87 ± 0.84; ST, 17.88 ± 0.92, p = NS), and principle diagnosis. PDT was performed more quickly (PDT, 20.1 ± 2.0 mins; ST, 41.7 ± 3.9 mins, p < .0001) and was associated with lower patient charges than ST (total patient charges: PDT, $1,569 ± $157 vs. ST, $3,172 ± $114; equipment/supply charges: PDT, $688 ± $103 vs. ST, $1,526 ± $87; professional charges: PDT, $880 ± $ 54 vs. ST, $1,647 ± $50; p < .0001 for all). There were no differences in days intubated before tracheostomy (PDT, 12.7 ± 1.1 days; ST, 15.6 ± 1.9, p = .20), intensive care unit length of stay (PDT, 24.5 ± 2.5 days; ST, 28.5 ± 3.1 days, p = .33), or hospital length of stay (PDT 49.7 ± 4.2 days; ST, 43.7 ± 3.5 days, p = .28) when we compared these two techniques. Conclusions: PDT is a cost-effective alternative to ST. The reduction in patient charges associated with PDT in this study resulted from the procedure being performed in the intensive care unit, thus eliminating the need for operating room facilities and personnel. PDT may become the procedure of choice for electively establishing tracheostomy in the appropriately selected patient who requires long-term mechanical ventilation.
KW - Anesthesiology
KW - Cost-effective
KW - Critical care
KW - Delivery of health care
KW - Health services research
KW - Mechanical ventilation
KW - Medicine
KW - Otolaryngology
KW - Percutaneous dilational tracheostomy
KW - Respiratory failure
KW - Surgery
KW - Surgical intensive care
KW - Surgical tracheostomy
KW - Technology
KW - Therapeutics
KW - traumatology
UR - http://www.scopus.com/inward/record.url?scp=0035011540&partnerID=8YFLogxK
U2 - 10.1097/00003246-200105000-00002
DO - 10.1097/00003246-200105000-00002
M3 - Article
C2 - 11378598
AN - SCOPUS:0035011540
SN - 0090-3493
VL - 29
SP - 926
EP - 930
JO - Critical care medicine
JF - Critical care medicine
IS - 5
ER -