Analysis of Tracheostomy Outcomes in ITU at Mater Dei Hospital
Retrospective analysis of tracheostomy outcomes in ITU patients at Mater Dei Hospital from 2013 to 2017. Examining mortality rates, length of stay, and ward discharges for patients with and without tracheostomies.
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A retrospective analysis of outcome after tracheostomy insertion in ITU at Mater Dei Hospital Dr Stephen Sciberras Dr Christabel Mizzi Dr Kenneth Muscat Dr Imed Ben Moussa Dr Ryan Grech
Introduction To analyse outcomes of patients who required a tracheostomy in ITU, and were subsequently discharged out of ITU.
Methods ITU in-patients January 2013- December 2017 Data from 2014 was incomplete Primary outcome was 30-day mortality Other outcomes included 14-day and 1-year mortality, length of stay in ITU Questionnaires given to nurses in general and speciality wards regarding tracheostomy care were compared to those given to nurses in ITU and ENT
Results 213 (9.4%) patients in ITU required a tracheostomy Tracheostomies in ITU 70 60 50 40 30 20 10 0 2013 2014 2015 2016 2017
213 trach performed in ITU 39 pts (18%) died 5 pts (2%) transferred to another hospital 71 pts (44%) tracheostomies removed in ITU 94 pts (56%) tracheostomies kept until transfer 64 pts (68%) with trachy to Special Ward 30 pts (32%) with trachy to Normal Ward
26 (22%)ENT 22 64 patients (54%) (18%)Neurosurgical Ward 94 patients discharged to a ward with a tracheostomy 16 (13%) Neuromedical Ward 29 (24%) Other ward 100% 80% 60% 40% 20% 0% 2013 2014 2015 2016 2017 Neuro ENT Normal
Mortality for patients discharged to ward with trachy Total Special Ward Normal Ward P-value 14-day mortality 11 / 88 (12.5%) 4 / 60 (6.7%) 7 / 28 (25%) 0.015 30-day mortality 13 / 88 (14.8%) 4 / 60 (6.7%) 9 / 28 (32.1%) 0.002 1-year mortality 33 / 88 (37.5%) 20 / 60 (33.3%) 13 / 28 (46.4%) 0.24 Mortality for patients discharged to ward without trachy Total Removed Not P-value Removed 14-day mortality 16 / 164 (7.3%) 5 / 65 (7.7%) 11 / 88 (12.5%) 0.33 30-day mortality 19 / 164 (11.6%) 6 / 65 (9.2%) 13 / 88 (14.8%) 0.30 1-year mortality 46 / 164 (28.0%) 13 / 65 (20.0%) 33 / 88 (37.5%) 0.020
In all patients discharged to ward, Age, LOS in ITU or Year (2013 - 2017) did not make a difference to 30- day mortality. 30-day mortality was also not affected by if the tracheostomy was removed in ITU or not. On multivariate analysis, only the place of discharge (Special vs Ward) made a difference. There was no difference between ENT and NMW / NSW.
Questionnaire information Questionnaires shows lack of knowledge on key aspects of trachy care Mean Score for Scenarios 12 10 8 6 4 2 0 Mean Score ITU / ENT Others
Recommendations Questionnaires show that there is lack of education A specialised unit would help to concentrate resources for patients with tracheostomy Outreach system to identify patients with tracheostomy who require further care Overall mortality of patient with tracheostomy is 11% at 30 days, and 28% at 1-year: so these are very sick patients
