title: Trends in Tracheostomy for Mechanically Ventilated Patients in the United States, 1993-2012.
abstract: BACKGROUND
  National trends in tracheostomy for mechanical ventilation (MV) patients are not well characterized.
  
  
  OBJECTIVE
  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.
  
  
  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.
authors.affiliation: 1 The Pulmonary Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Anuj B
authors.initials: AB
authors.lastname: Mehta
authors.affiliation: 1 The Pulmonary Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.|2 VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Sohera N
authors.initials: SN
authors.lastname: Syeda
authors.affiliation: 1 The Pulmonary Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bajpayee
authors.affiliation: 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; and.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Cooke
authors.affiliation: 1 The Pulmonary Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Walkey
authors.affiliation: 1 The Pulmonary Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.|4 Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, Massachusetts.
authors.forename: Renda Soylemez
authors.initials: RS
authors.lastname: Wiener
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy / Q000706:statistics & numerical data*; D014481:United States
keywords: United States; epidemiology; mechanical ventilation; tracheostomy