title: Medical economic impact of tracheotomy patients on a hospital system.
abstract: BACKGROUND
  Tracheotomy patients are a small portion of hospitalizations, but account for disproportionately high risk and costs. There are many complex decisions that go into the care of these patients, and practice variation is expected to be compounded in a health system. This study sought to characterize the medical economic impact of tracheotomy patients on the hospital system.
  
  
  METHODS
  A retrospective review of the health system's hospital billing software was performed for 2013, and pertinent outcomes measures were tabulated.
  
  
  RESULTS
  There were 829 tracheotomies performed in the health system of seven hospitals, with total costs of $128,883,865. Average length of stay was 36.74 days for principal procedures, and 43.36 days for tracheotomy as secondary procedures. Mortality was ∼ 18% overall, and re-admissions were 10.93% for primary, and 14.36% for secondary procedures. A fairly wide variation in each category among the different hospitals was observed.
  
  
  CONCLUSIONS
  There are potentially many factors that impact variations of care and outcomes in patients with tracheotomy. Due to their large economic impact and risks for morbidity and mortality, a formalized care pathway is warranted. Goals of the pathway should include understanding medical decisions surrounding these complex patients, monitoring pertinent outcomes, reducing practice variation, and improving the efficiency of compassionate care.
authors.affiliation: Department of Otolaryngology, Baylor College of Medicine , Houston, TX , USA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Altman
authors.forename: Karen Merl
authors.initials: KM
authors.lastname: Banoff
authors.forename: Charles C L
authors.initials: CC
authors.lastname: Tong
mesh_terms: D000067:Accounts Payable and Receivable; D003657:Decision Making; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D009518:New York; D010043:Outcome and Process Assessment, Health Care / Q000191:economics* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014140:Tracheotomy / Q000191:economics*
keywords: Care pathway; Economic impact; Health system; Hospital; Length of stay; Medical decision-making; Mortality; Outcomes; Population management; Readmission; Tracheostomy; Tracheotomy