Cost Effectiveness of a Bedside Tracheostomy Versus Operating Room While Using a #6 Tracheostomy

Abstract

Background: Annually there are approximately 100,000 tracheostomies performed nationwide. While a common practice with critically ill patients, tracheostomy placement does not come without significant potential for risk. This retrospective data analysis was developed to analyze the practice of bedside versus operating room (OR) with respect to cost effectiveness and progression to potential decannulation

Methods: This study received IRB approval from Atrium Health. Data was analyzed for 75 patients that were admitted to Atrium Health Main with either the diagnosis of traumatic brain injury (TBI) or spinal cord injury (SCI) and had received a tracheostomy. Demographics, mechanical ventilation support, and surgical history were assessed to determine if there were any barriers to performing a bedside percutaneous tracheostomy. A #6 tracheostomy tube was used on all patients unless otherwise specified by referring physician. Age, tracheostomy size, and time-to-tracheostomy were compared to initial pass rates of a swallow test via Mann-Whitney U analysis.

Results: From 2016-2017, 82 tracheostomies were performed; 36 of which were placed at bedside with 11 placed in the OR. In 2017, 35 tracheostomies were performed; 26 were placed at bedside and 9 in the OR; all were size #6. There was not a statistically significant finding within the analyzed domains regarding impact on swallow test pass/fail (P >0.05 for all domains). On average the cost for an OR tracheostomy is $4,600.00 and bedside approximate cost is $500.00. We had a total cost savings of $354,200.00.

Conclusions: After comparing the cost of bedside versus OR tracheostomy procedure, it was concluded that it is more cost effective to perform bedside tracheostomies. Age, time-to-tracheostomy and tracheostomy size did not have a significant impact on passing a swallow test.