Clinical outcomes for the elderly patient receiving a tracheotomy.
BACKGROUND
Tracheotomies are routinely performed for severely ill and elderly patients with respiratory failure. This intervention is questioned, given the poor survival rate in this group. Outcomes analysis is performed after tracheotomy.


METHODS
This is a retrospective study of 78 elderly patients, who received tracheotomies for respiratory failure. Pretracheotomy data (age, length of oral intubation, and DNR status) were collected. Outcomes analyzed during the same admission as the tracheotomy included death versus discharge, ventilator dependence, vocal function, route of feeding, decannulation, and ICU discharge disposition.


RESULTS
The mean age was 77.6 +/- 11 years (median, 79 years) and patients were intubated for 16.7 +/- 9 days. Forty-two percent (n = 33) obtained DNR orders after tracheotomy, and 8% (n = 6) before tracheotomy. Seventy-one percent of patients (n = 55) had gastrostomy tubes placed. Fifty-six percent of patients (n = 44) died after tracheotomy; median time from tracheotomy to death was 31 days. After tracheotomy, 53 % (n = 41) remained at least partially ventilator dependent, 18 % (n = 14) regained consistent vocal function, and 13 % (n = 10) were decannulated. For those who died, 27 % (n = 12) died without leaving the ICU.


CONCLUSIONS
These data demonstrate that a large proportion of elderly, severely ill patients with respiratory failure suffer poor outcomes after tracheotomy. More stringent criteria are necessary for performing the tracheotomy in this patient population.
Baskin
Jonathan Zvi
JZ
Department of Otolaryngology and Head and Neck Surgery, New York University School of Medicine, 1317 3rd Ave., New York, New York 10021, USA. jzb@woorldnet.att.net
Panagopoulos
Georgia
G
Parks
Christine
C
Rothstein
Stephen
S
Komisar
Arnold
A
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000401:mortality / Q000601:surgery*; D016414:Resuscitation Orders; D012189:Retrospective Studies; D014140:Tracheotomy; D014481:United States