Mortality associated with tracheostomy complications in the United States: 2007–2016

Abstract

Objectives/Hypothesis To investigate patterns of tracheostomy‐associated death in the United States. Study Design Retrospective database review. Methods We used Multiple Cause‐of‐Death data from the Centers for Disease Control and Prevention to determine cumulative national mortality associated with tracheostomy complications in the United States from 2007 to 2016. Using International Classification of Diseases, Tenth Revision data, we investigated how frequently tracheostomy‐related complications were reported in cause of death data. We then compared the characteristics of patients with tracheostomy‐related mortality to patients reported to have died of other causes. Results Over the 10‐year period studied, we identified 623 tracheostomy‐related deaths (537 adults and 86 children) out of 25,587,306 total deaths reported. Although absolute mortality was higher in adults, the reported base rate of tracheostomy complication–associated mortality was tenfold higher in children. Most tracheostomy‐related deaths occurred in a hospital facility (74.5% in adults). Deaths associated with tracheostomy complications were significantly more common for African American children (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.26‐3.24) and adults (OR: 1.59, 95% CI: 1.29‐1.96) or in Hispanic adults (OR: 1.42, 95% CI: 1.06‐1.89). Deaths related to a tracheostomy complication more commonly occurred on the weekend (OR: 1.24, 95% CI: 1.04‐1.49) and in the most recent 2‐year period (OR: 1.31, 95% CI: 1.03‐1.68). Adults with a bachelor's, master's or doctorate degree were significantly less likely to have mortality associated with a tracheostomy‐related complication (OR: 0.54, 95% CI: 0.39‐0.75). Conclusions Tracheostomy‐related complications were implicated in the deaths of a significant number of individuals. Several demographic groups had increased likelihood of tracheostomy‐related mortality. Future research is necessary to develop targeted interventions to decrease harm. Level of Evidence NA Laryngoscope, 129:619–626, 2019

Oral Intubation Attempts in Patients With a Laryngectomy: A Significant Safety Threat

“…2 Uninformed clinicians may attempt to bag mask or orally intubate patients with laryngectomy stomas, potentially causing preventable harm. While tracheostomy-related mortality is well studied, 3 there are minimal data on the oral intubation of patients with a laryngectomy.…”

Influence of Insurance Status and Demographic Factors on Outcomes Following Tracheostomy

“…In contrast, black patients in our cohort did not have a higher 30‐day mortality rate despite having overall higher CCI. The discrepancy in mortality rates between black and Hispanic patients contrasts to trends seen in the literature, where black and Hispanic patients often track together in terms of outcomes 19 . Other factors that affect Hispanic‐identifying patients may be at play.…”

Regarding “Mortality Associated With Tracheostomy Complications in the United States: 2007–2016”

“…1 From this data, the incorrect conclusion could be drawn that tracheostomy-related deaths are very rare events. The authors identified 623 tracheostomy-related deaths of 25,587,306 total deaths reported and recommended further studies.…”