Cost/benefit analysis of open tracheotomy, in the or and at the bedside, with percutaneous tracheotomy

(1) To determine whether percutaneous dilational tracheotomy (PDT), open tracheotomy in the operating room (OT/OR), and open tracheotomy at the bedside (OT/BS) are equally safe; and (2) to determine which procedure was most cost effective.

Retrospective review of patient medical records and billing data.

Any adult patient (>20 y of age) on the medical or surgical services at Penn State Milton S. Hershey Medical Center who required a tracheotomy, elective or emergent, from September 1996 to July 1997 was included. The decision to perform OT in the OR, PDT, or OT at BS was made by the attending surgeon independent of this study. Each patient's course after tracheotomy was reviewed. All complications, perioperatively or postoperatively, for up to 10 days were documented. The complications were divided into two groups: major and minor. Determination of patient cost used surgical billing and OR materials staff records. The necessary equipment and staff for each procedure was determined, and an itemized cost list was retrospectively developed for a typical PDT, OT in OR, or OT at BS. The P values were calculated with the Cochran-Mantel-Haenszel (CMH) chi(2) test of association.

All procedures were equally safe, with PDT being the most cost effective.

This report confirms the results of several studies demonstrating that PDT, OT in the OR, and OT at the BS are equally safe; PDT appears to be most cost effective. Our analysis, however, does reveal several options for decreasing the cost of bedside tracheotomy to allow this procedure to be even more cost effective than PDT.