Percutaneous dilational tracheostomy in neurosurgical patients

Tracheostomy is often performed in patients requiring long-term mechanical ventilation after severe neurological injury. Percutaneous dilational tracheostomy (PDT) is an alternative to traditional surgical tracheostomy (TST) for creating a tracheostomy. We compared these techniques in neurosurgical patients and assessed the impact on cost and clinical course.

We conducted a retrospective chart review of 81 neurosurgical patients treated with either PDT (n = 43) or TST (n = 38). Several clinical endpoints were examined, including days intubated prior to tracheostomy, length of hospital stay, procedural complications, and overall procedure costs.

No serious complications occurred with PDT, whereas two minor postoperative complications occurred in the TST group. The time from intubation to tracheostomy was 8 days for the PDT group versus 13 days for the TST group (p < 0.001), and the time from intubation to discharge from the hospital was 20 days for the PDT group compared to 27 days for the TST group (p < 0.005). In our institution, the average cost of PDT was $980.69 less than the cost for TST.

PDT appears to have a low incidence of complications in neurosurgical patients and may shorten the length of hospitalization and the overall cost compared with TST.