Trends in Tracheostomy for Mechanically Ventilated Patients in the United States, 1993-2012
Trends in Tracheostomy for Mechanically Ventilated Patients in the United States, 1993-2012
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DOI：
10.1164/rccm.201502-0239oc
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发表时间：
2015-08-15
影响因子：
24.7
通讯作者：
Wiener, Renda Soylemez
中科院分区：
文献类型：
--
作者：
Mehta, Anuj B.;Syeda, Sohera N.;Wiener, Renda Soylemez
理由：机械通气（MV）患者气管切开术的全国趋势尚未很好地表征。目的：调查美国气管切开术的使用趋势、时机和结果。方法：我们计算了1993 - 2012年全国住院患者样本中气管切开术的使用和结果。我们使用分层模型来确定与MV患者气管切开术相关的因素。测量和主要结果：我们确定了从1993年到2012年接受气管切开术的1,352,432名成年人（占MV患者的9.1%）。气管切开术在外科患者、男性和少数民族中更为常见。经年龄调整的气管切开术发病率增加了106%，与MV的使用不成比例地增加。气管切开术在MV患者中的比例从1993年的6.9%上升到2008年的9.8%，2012年下降到8.7% （P < 0.0001）。气管造口术的使用增加主要由手术患者驱动（1993年为9.5%，2012年为15.0%,P < 0.0001），非手术患者变化不大（1993年为5.8%，2012年为5.9%,P < 0.0001）。随着时间的推移，气管切开术的实施时间越早（中位数为1998年11天，2012年10天，P < 0.0001），住院时间越长（中位数为1993年39天，2012年26天，P < 0.0001），住院率上升（40.1%比71.9%,P < 0.0001），住院死亡率下降（38.1%比14.7%,P < 0.0001）。结论：在过去的二十年中，气管切开术的使用在美国大幅上升，直到2008年才开始下降。观察到的气管切开术患者出院到长期护理机构的急剧增加可能对临床护理、医疗保健费用、政策和研究具有重要意义。在分析气管切开术的结果时，未来的研究应包括长期设施。
Rationale: National trends in tracheostomy for mechanical ventilation (MV) patients are not well characterized.Objectives: To investigate trends in tracheostomy use, timing, and outcomes in the United States.Methods: We calculated estimates of tracheostomy use and outcomes from the National Inpatient Sample from 1993 to 2012. We used hierarchical models to determine factors associated with tracheostomy use among MV patients.Measurements and Main Results: We identified 1,352,432 adults who received tracheostomy from 1993 to 2012 (9.1% of,MV patients). Tracheostomy was more common in surgical patients, men, and racial/ethnic minorities. Age-adjusted incidence of tracheostomy increased by 106%, rising disproportionately to MV use. Among MV patients, tracheostomy rose from 6.9% in 1993 to 9.8% in 2008, and then it declined to 8.7% in 2012 (P < 0.0001). Increases in tracheostomy use were driven by surgical patients (9.5% in 1993; 15.0% in 2012; P < 0.0001), with little change among nonsurgical patients (5.8% in 1993; 5.9% in 2012; P < 0.0001). Over time, tracheostomies were performed earlier (median, 11 d in 1998; 10 d in 2012; P < 0.0001), whereas hospital length of stay declined (median, 39 d in 1993; 26 d in 2012; P < 0.0001), discharges to long-term facilities increased (40.1% vs. 71.9%; P < 0.0001), and hospital mortality declined (38.1% vs. 14.7%; P < 0.0001).Conclusions: Over the past two decades, tracheostomy use rose substantially in the United States until 2008, when use began to decline. The observed dramatic increase in discharge of tracheostomy patients to long-term care facilities may have significant implications for clinical care, healthcare costs, policy, and research. Future studies should include long-term facilities when analyzing outcomes of tracheostomy.