Trends in Tracheostomy Utilization, Tracheostomy Dependence, and Outcomes Before and After the COVID-19 Pandemic

The COVID-19 pandemic led to an unprecedented demand for invasive mechanical ventilation and may have affected tracheostomy utilization, dependence, and airway-related outcomes. However, population-level trends before and after the pandemic remain poorly characterized. We evaluated temporal trends in tracheostomy utilization, dependence, and airway-related complications among intubated and mechanically ventilated patients before versus after the COVID-19 pandemic.

We conducted a retrospective cohort study using de-identified data from the TriNetX U.S. Collaborative Network. Adults (≥ 18 years) who underwent endotracheal intubation and respiratory ventilation from 2016 to 2023 were included. Patients were stratified into pre-pandemic (2016-2019) and pandemic (2020-2023) cohorts. Propensity score matching was performed on 13 demographic and clinical covariates. Primary outcomes were tracheostomy and tracheostomy dependence, and secondary outcomes included airway-related complications. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.

Among 155,499 intubated and mechanically ventilated patients, the incidence proportions of tracheostomy, tracheostomy dependence, and dysphagia increased from 2016 to 2023 by approximately 2.1, 3.3, and 2.3 times, respectively. After matching (n = 64,732 per cohort), there was no difference in tracheostomy surgical rates between pre- and pandemic cohorts (RR: 0.97, 95% CI: 0.91-1.02). However, pandemic patients had higher risks of tracheostomy dependence (RR: 1.14, 95% CI: 1.08-1.21) and dysphagia (RR: 1.07, 95% CI: 1.04-1.10).

Tracheostomy dependence and select airway complications increased in the pandemic period, suggesting lasting downstream effects of critical care practices after the pandemic. Proactive resource planning and long-term strategies for airway care in tracheotomized patients are needed.

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