title: A prospective, randomized study comparing percutaneous with surgical tracheostomy in critically ill patients.
abstract: OBJECTIVE
  To determine the relative cost-effectiveness of percutaneous dilational tracheostomy (PDT) and surgical tracheostomy (ST) in critically ill patients.
  
  
  METHODS
  Prospective randomized study.
  
  
  METHODS
  Medical, surgical, and coronary intensive care units at Barnes-Jewish Hospital, a tertiary care medical center.
  
  
  METHODS
  Eighty critically ill mechanically ventilated patients requiring elective tracheostomy.
  
  
  METHODS
  Randomization to either PDT performed in the intensive care unit or ST performed in the operating room.
  
  
  RESULTS
  Treatment groups were well matched with respect to age (PDT, 65.44 +/- 2.82 [mean +/- se] years; ST, 61.4 +/- 2.89 years, p = Ns), gender (PDT, 45% males; ST, 47.5% males, p = NS), severity of illness (Acute Physiology and Chronic Health Evaluation II score: PDT, 16.87 +/- 0.84; ST, 17.88 +/- 0.92, p = NS), and principle diagnosis. PDT was performed more quickly (PDT, 20.1 +/- 2.0 mins; ST, 41.7 +/- 3.9 mins, p < .0001) and was associated with lower patient charges than ST (total patient charges: PDT, 1,569 dollars +/- 157 dollars vs. ST, 3,172 dollars +/- 114 dollars; equipment/supply charges: PDT, 688 dollars +/- 103 dollars vs. ST, 1,526 dollars +/- 87 dollars; professional charges: PDT, 880 dollars +/- 54 dollars vs. ST, 1,647 dollars +/- 50 dollars; p < .0001 for all). There were no differences in days intubated before tracheostomy (PDT, 12.7 +/- 1.1 days; ST, 15.6 +/- 1.9, p = .20), intensive care unit length of stay (PDT, 24.5 +/- 2.5 days; ST, 28.5 +/- 3.1 days, p = .33), or hospital length of stay (PDT 49.7 +/- 4.2 days; ST, 43.7 +/- 3.5 days, p = .28) when we compared these two techniques.
  
  
  CONCLUSIONS
  PDT is a cost-effective alternative to ST. The reduction in patient charges associated with PDT in this study resulted from the procedure being performed in the intensive care unit, thus eliminating the need for operating room facilities and personnel. PDT may become the procedure of choice for electively establishing tracheostomy in the appropriately selected patient who requires long-term mechanical ventilation.
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: B D
authors.initials: BD
authors.lastname: Freeman
authors.forename: K
authors.initials: K
authors.lastname: Isabella
authors.forename: J P
authors.initials: JP
authors.lastname: Cobb
authors.forename: W A
authors.initials: WA
authors.lastname: Boyle
authors.forename: R E
authors.initials: RE
authors.lastname: Schmieg
authors.forename: M H
authors.initials: MH
authors.lastname: Kolleff
authors.forename: N
authors.initials: N
authors.lastname: Lin
authors.forename: T
authors.initials: T
authors.lastname: Saak
authors.forename: E C
authors.initials: EC
authors.lastname: Thompson
authors.forename: T G
authors.initials: TG
authors.lastname: Buchman
mesh_terms: D003362:Cost-Benefit Analysis; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D014139:Tracheostomy / Q000191:economics / Q000379:methods*