A prospective, randomized study comparing percutaneous with surgical tracheostomy in critically ill patients

Area of Science:

• Critical Care Medicine
• Surgical Procedures
• Health Economics

Background:

• Tracheostomy is a common procedure for critically ill patients requiring prolonged mechanical ventilation.
• Both percutaneous dilational tracheostomy (PDT) and surgical tracheostomy (ST) are established methods for airway management.
• Assessing the cost-effectiveness of different tracheostomy techniques is crucial for resource allocation in intensive care settings.

Purpose of the Study:

• To compare the cost-effectiveness of percutaneous dilational tracheostomy (PDT) versus surgical tracheostomy (ST) in critically ill patients.
• To evaluate procedural efficiency and associated patient charges for both PDT and ST.

Main Methods:

• A prospective randomized study was conducted with 80 critically ill, mechanically ventilated patients requiring elective tracheostomy.
• Patients were randomized to undergo either PDT in the intensive care unit or ST in the operating room.
• Key outcomes included procedure time, patient charges (total, equipment/supplies, professional), intubation duration, and length of stay.

Main Results:

• PDT procedures were significantly faster (20.1 min vs. 41.7 min) and associated with substantially lower patient charges compared to ST (1,569 USD vs. 3,172 USD).
• No significant differences were observed in the duration of mechanical ventilation before tracheostomy, ICU length of stay, or overall hospital length of stay between the two groups.
• Patient demographics, severity of illness, and primary diagnoses were comparable between the PDT and ST groups.

Conclusions:

• Percutaneous dilational tracheostomy (PDT) presents a cost-effective alternative to surgical tracheostomy (ST) for elective airway management in critically ill patients.
• The cost savings associated with PDT are primarily attributed to its performance within the intensive care unit, avoiding operating room expenses.
• PDT is a viable and potentially preferred procedure for selected patients requiring long-term mechanical ventilation.