Complications and 30-day hospital readmission rates of patients undergoing tracheostomy: A prospective analysis

Objective: To determine inpatient and outpatient tracheostomy complication rates and 30-day hospital readmission rates, and to assess patient and procedural risk factors associated with complications and readmissions. Study Design: Prospective cohort study. Methods: Adult patients undergoing tracheostomy at a single academic hospital performed by any service, for any indication, were enrolled in this study over the course of 1 year. All patients had complete 30-day follow-up after discharge to determine complication and hospital readmission rates. Logistic regression was used to assess patient and procedural risk factors associated with these events. Results: One hundred patients were enrolled in this study from June 1, 2015, to June 1, 2016. The overall inpatient tracheostomy complication rate was 47% (95% confidence interval [CI], 37%–57%). Inpatient complications were associated with location in the medical intensive care unit and increased length of hospitalization. The outpatient tracheostomy complication rate was 15% (95% CI, 8%–22%). Outpatient complications were associated with having a previous tracheostomy or an awake tracheostomy under local anesthesia. The all-cause 30-day hospital readmission rate was 33% (95% CI, 24%–42%), and the tracheostomy-specific readmission rate was 13% (95% CI, 6%–20%). All-cause readmissions were associated with diabetes, length of hospitalization after tracheostomy, and outpatient complications. The overall mortality rate during the study period was 11% (95% CI, 5%–17%), with one tracheostomy-related death. Conclusion: Patients undergoing tracheostomies are at high risk for both inpatient and outpatient complications, as well for 30-day hospital readmission. Understanding patient and procedural risk factors associated with these events will help guide interventions for quality improvement. Level of Evidence: 2b. Laryngoscope, 127:2746–2753, 2017.