Utilisation of tracheostomy in patients with COVID-19 in England:
patient characteristics, timing and outcomes
Abstract
Objectives: We aimed to characterise the use of tracheostomy procedures
for all COVID-19 critical care patients in England and to understand how
patient factors and timing of tracheostomy affected outcomes. Design: A
retrospective observational study using exploratory analysis of hospital
administrative data. Setting: All 500 National Health Service hospitals
in England. Participants: All hospitalised COVID-19 patients aged ≥ 18
years in England between March 1st and October 31st, 2020 were included.
Main outcomes and measures: This was a retrospective exploratory
analysis using the Hospital Episode Statistics administrative dataset.
Multilevel modelling was used to explore the relationship between
demographic factors, comorbidity and use of tracheostomy and the
association between tracheostomy use, tracheostomy timing and the
outcomes. Results: In total, 2,200 hospitalised COVID-19 patients had a
tracheostomy. Tracheostomy utilisation varied substantially across the
study period, peaking in April-June 2020. In multivariable modelling,
for those admitted to critical care, tracheostomy was most common in
those aged 40-79 years, in males and in people of Black and Asian ethnic
groups and those with a history of cerebrovascular disease. In critical
care patients, tracheostomy was associated with lower odds of mortality
(OR: 0.514 (95% CI 0.443 to 0.596), but greater length of stay (OR:
41.143 (95% CI 30.979 to 54.642). In patients that survived, earlier
timing of tracheostomy (≤ 14 days post admission to critical care) was
significantly associated with shorter length of stay. Conclusions:
Tracheostomy is safe and advantageous for critical care COVID-19
patients. Early tracheostomy may be associated with better outcomes,
such as shorter length of stay, compared to late tracheostomy.