Open bedside tracheotomy: impact on patient care and patient safety

Objectives were: 1) to evaluate the impact of open bedside tracheotomy (OBT) on patient care and 2) to determine whether OBT in the intensive care unit (ICU) is a safe, cost-effective procedure.

Retrospective chart-based review.

A total of 163 consecutive adult patients in the medical or surgical ICU who underwent OBT by the Otorhinolaryngology service from July 2007 to July 2009, in addition to the 163 consecutive adult patients who had undergone open tracheotomy in the operating room immediately prior to July 2007, were included in the study. Data examined included time intervals between initial consultation and performance of tracheotomy, complication rates, ICU length of stay, and cost considerations.

In the group of patients examined prior to OBT, time to surgery (TTS) averaged 3.24 days in comparison to an average of 1.48 days for patients who received OBT (P < .05). Review of complications revealed no significant difference in the two study groups (odds ratio [OR], 1.42, 95% confidence interval [CI], 0.44-4.56, P = .56). The length of ICU stay decreased by 0.6 days on average in the OBT group versus the OR group, although not achieving statistical significance (P = .18). Cost analysis suggests a potential savings of $4,575 per case, resulting in approximately $745,700 saved in the OBT group.

Review of our experience demonstrates comparable safety for tracheotomy performed bedside versus in the operating room, while offering shorter time to surgery, decreased costs, and perhaps a reduction in the length of ICU stay. These findings suggest that open bedside tracheotomy is preferable to tracheotomy performed in the operating room for patients in the ICU setting.