Risk factors for futile tracheostomy: an analysis of the NIS database.

Abstract

INTRODUCTION: Respiratory insufficiency and failure are leading causes of ICU admissions. Advances in medical technology allow prolonging of survival in critical illnesses. Hence, more tracheostomies are being performed. However, we are limited in predicting who may actually benefit. Our goal was to determine prognostic indicators of early mortality after tracheostomy in order to avoid futile procedures. MATERIAL AND METHODS: We performed a retrospective cohort study utilizing the National Inpatient Sample (NIS) database on all adults who underwent tracheostomy between 2005 and 2015. We defined futile tracheostomy as death within 30 days post tracheostomy during the same hospital admission. Univariate and multivariate testing were performed on the weighted dataset. Odds ratios (OR) were calculated with multivariate logistic regression testing. RESULTS: 851,020 cases met the inclusion criteria. Rate of futility was 12.4% (n=105,658). Total hospitalization cost was greater in the futile group as compared to non-futile group. On Multivariate testing, male gender, age greater than 65, 3 Elixhauser mortality index categories, Asian/Pacific Islander and other race, self-pay and no charge insurance, septicemia and mechanical ventilation greater than 96 hours were independent risk factors to predict futility. Among these, septicemia was the greatest risk for futility (OR 2.32), followed by Elixhauser mortality index >10 (OR 1.954), and Elixhauser mortality index between 3 and 10 (OR 1.468). CONCLUSIONS: Between 2005 and 2015, 12.4% of tracheostomies could be considered futile. Targeted efforts are needed to decrease the number of unnecessary procedures in the critically ill. We should consider the identified risk factors to share more informed discussions with patients and families to set better long-term expectations and realistic goals for care.

Keywords

• critical care
• tracheostomy
• complication
• mortality
• risk factors.