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High resource utilization does not affect mortality in acute respiratory failure patients managed with tracheostomy
Bradley D Freeman1, Dustin Stwalley, Dennis Lambert
1Department of Surgery.
Respiratory Care
|May 8, 2013
Summary
Higher healthcare spending in academic medical centers did not improve outcomes for patients with acute respiratory failure (ARF) undergoing tracheostomy. Increased resource intensity was linked to higher mortality, especially when complications arose.
Area of Science:
- Critical Care Medicine
- Health Services Research
- Pulmonary Medicine
Background:
- Tracheostomy practices for acute respiratory failure (ARF) vary across institutions, potentially impacting resource use and patient outcomes.
- Previous healthcare studies suggest a correlation between higher resource expenditure and improved patient outcomes.
Purpose of the Study:
- To investigate the association between institutional resource intensity and mortality rates in ARF patients who have undergone tracheostomy.
- To determine if higher resource expenditure in academic medical centers influences survival in ARF patients managed with tracheostomy.
Main Methods:
- Utilized the University Health Systems Consortium database, analyzing administrative coding data for ARF patients.
- Developed multivariable models incorporating patient demographics, clinical variables, and institution-level resource intensity (cost) to assess mortality risk.
- Risk-adjusted estimates of costs were used to determine the mean resource intensity of participating academic medical centers.
Main Results:
- Analysis of 44,124 ARF patients revealed that 10.8% underwent tracheostomy.
- Treatment in high-resource-intensity centers was associated with an increased risk of mortality (OR 1.11) compared to low-resource settings, including those with tracheostomy (OR 1.10).
- While complication profiles did not differ, tracheostomy patients with complications had higher mortality in high-resource (30.3%) versus low-resource (21.3%) centers.
Conclusions:
- No positive association was found between increased resource expenditure and improved outcomes for ARF patients managed with tracheostomy.
- Higher resource intensity in academic medical centers correlated with increased mortality risk in this patient population.
- Resource expenditure did not appear to mitigate mortality risks associated with complications in tracheostomy patients.
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