Hospital and long-term outcome after tracheostomy for respiratory failure

Objective: To determine the patient characteristics, hospital course, hospital cost, posthospital survival, and functional outcome in a group of patients with tracheostomy for respiratory failure. Design: Retrospective chart review combined with prospective evaluation of functional status. Setting: An urban, tertiary-care medical center. Patients: Adult patients with tracheostomy for respiratory failure between January 1, 1998, and December 31, 2000. Methods: Retrospective chart review and prospective administration of the Short Form-36 (SF-36) for health status outcome. Results: Four hundred twenty-nine patients were studied. Hospital mortality was 19%. Only 57% of survivors were liberated from mechanical ventilation. At 100 days, 6 months, 1 year, and 2 years after discharge, 24%, 30%, 36%, and 42% of hospital survivors had died, respectively. Patients liberated from mechanical ventilation and having their tracheostomy tubes decannulated had the lowest mortality (8% at 1 year); the mortality of ventilator-dependent patients was highest (57%). Sixty-six patients completed the SF-36 for functional status. While emotional health was generally good, physical function was quite limited. Median hospital direct variable cost was $29,340. Conclusion: Overall survival and functional status are poor in patients with tracheostomy for respiratory failure. Patients who are liberated from mechanical ventilation and have their tracheostomy tubes removed have the best survival; however, it comes at a higher hospital cost and longer length of stay.