Background

Analyze the complication incidence, resource utilization and cost-effectiveness between two methods of tracheotomy: traditional open surgical (TOS) versus percutaneous dilational tracheotomy (PDT). Subjects: Retrospective-case paired study at an Urban Level I Trauma Center. The study population consisted of adult (>18years of age) intubated trauma patients in the trauma intensive care unit (TICU) selected for tracheotomy placement between October 2004 and June 2005. Main Outcome Measures:  Peri-operative complications, comparison of procedural cost, and utilization of hospital resources. METHODS:  Determination of procedural cost was estimated upon review of surgical billing and operating room material staff records.  An itemized cost list was retrospectively developed for the typical PDT and the TOS.  For all TOS tracheotomies a full OR/anesthesia team and necessary equipment were utilized.  For all PDT?s the procedure was performed at bedside using a critical care nurse, respiratory therapist, necessary medications, and a commercially available PDT kit.

Results

From October, 2004 to June, 2005 selected critical care trauma patients who underwent bedside modified PDT were paired-up respectively according to age, injury severity score and length of  ICU stay; to those undergoing TOS. A total of eight (8) patients had successfully undergone PDT?s. The PDT group consisted of 7 men and 1 woman with a mean age of 44.4 +/- 20.7 years (range, 21-81 years). The mean ISS score was 30.8 +/-11.0 (range, 17-41). The length of operation was 11.9 min. +/- 2.1 minutes for PDT?s and 21.1 min. +/- 4.07 minutes for the open surgical tracheotomies (p<0.0001). There was no peri-operative complications associated with the PDT?s or the TOS tracheotomies. The average cost incurred by the hospital for the bedside PDT was $260.00, while the average cost incurred for the TOS was $1,045.00. Projecting these results to 100 bedside tracheotomies, gives us an institutional savings of approximately $78,500.00 per 100 cases. A cost analysis for PDT?s versus open surgical tracheotomies is broken down in the following Table:
 

OST=open surgical tracheotomy; OR=operating room; PDT=percutaneous dilational tracheotomy.

Conclusions

Total hospital cost incurred was considerably less for those patients that underwent the modified PDT. The PDT required fewer hospital resources. The incidence of complications was similar for both procedures.