Is tracheotomy on the decline in otolaryngology? A single institutional analysis

Publication date: Available online 20 December 2017
Source:American Journal of Otolaryngology
Author(s): Andrew J. Bowen, Amy S. Nowacki, Michael S. Benninger, Eric D. Lamarre, Paul C. Bryson
ObjectiveA recent study reported decreasing trends in tracheotomy procedures by its otolaryngology service. We set out to determine whether the previously reported decrease in otolaryngology performed tracheotomies by one institution is a local or generalizable phenomenon.DesignRetrospective cohort study from 2010 to 2015.SettingTertiary care hospital and affiliated regional hospitals.Subject and methodsAll patients who received tracheotomy during the period of analysis were included. Performing specialty, surgical technique, and procedure location were recorded. Procedures were stratified by year and specialty to generate incidence rate ratios for otolaryngologists and non-otolaryngologists. Incidence rate ratios were estimated with negative binomial regression across services.ResultsThe otolaryngology service demonstrated a yearly decrease of 3.4% in the total number of tracheotomies (95% CI −7.9% to +1.4, P=0.17). While the thoracic service remained constant (+0.3%, 95% CI −2.6% to +3.3%, p=0.83), general surgery demonstrated the greatest increase in procedures (+4.4%, 95% CI −6.0% to +15.8%, P=0.42). Thoracic and general surgery both dramatically increased the number of percutaneous tracheotomies performed, with general surgery also performing a greater number of bedside procedures.Conclusions and relevanceWe observed a similar decline in the number of tracheotomies otolaryngology over six years. Our trend is likely due to changes in consultations patterns, increasing use of the percutaneous method, and an increase in adjunctive gastrostomy tube placements. Investigations on the impact of a greater number of non-otolaryngology performed tracheotomies on follow up care is warranted.



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