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Comprehensive Otolaryngology

(505) Tracheostomy Incidence and Complications: A National Database Analysis

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
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    Presenting Author(s)

  • William A. Strober, MD

    Postdoctoral Research Scholar
    Washington University/BJH/SLCH Consortium
    Saint Louis, Missouri, United States

    • Co-Author(s)

  • Jay F. Piccirillo, MD

    Professor, Vice Chair for Research
    Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine
    St. Louis, MO, United States

  • DK

    Dorina Kallogjeri, MD, MPH

    Assistant Professor
    Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine
    St Louis, Missouri, USA

    • Senior Author(s)

  • MR

    Matthew L. Rohlfing, MD

    Assistant Professor
    Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, USA

Disclosure(s):
William A. Strober, MD: No relevant relationships to disclose.


Introduction: Tracheostomy is a common procedure that is associated with significant complications. This study aimed to describe the incidence of tracheostomy-related complications and identify prognostic risk factors.

Methods: PearlDiver, a private analytics database consisting of insurance claims from Medicare, Medicaid, and commercial insurance companies, was used to identify patients who underwent tracheostomies between January 2010 and October 2021 by CPT codes. Patients with at least one tracheostomy-related complication within 90 days of the tracheostomy were identified based on ICD-9/ICD-10 codes.

Results: We identified 196,971 patients who underwent tracheostomies. A total of 18,339 (9.3%) patients had tracheostomy-related complications within 90 days of the procedure.

The mean (±SD) age of patients who underwent tracheostomy was 59.4 (14.7), range 18-83. 42.5% of patients were ≥65 years of age and 113,708 (57.7%) were male. Elixhauser Comorbidity Index (ECI) scores ranged from 0-25, median=8. Specialties that performed the greatest number of tracheostomies were otolaryngology (28%), general surgery (26%), and critical care surgery (13%).

There was an increase in number of tracheostomies over time, with 8,007 more tracheostomies performed in 2020 compared to 2010. There was also an increase in proportion of complications over time, with a peak of 2.3 times more in 2019 compared to 2010. The most common complication codes were mechanical complication / obstruction / tracheal stenosis (6,302, 3.20%) and hemorrhage (3,260, 1.66%). ECI scores among patients with complications ranged from 0-24, median=9. For every 1-point increase in ECI score there was a 6.1% increase in risk of developing a complication. The risk of developing a complication did not significantly change with age, sex, or region.

Conclusions: Complications after tracheostomy are common and are related to overall burden of comorbidity. This information may be helpful for quality improvement programs, counseling patients and their families on tracheostomy risks, and informing the design of studies on the outcomes of tracheostomies.