Comparative analysis of bedside and operating room tracheostomies in critically ill patients with burns

The objective of this study was to demonstrate that bedside burn intensive care unit tracheostomy is a safe and cost-effective procedure and has advantages over operating room tracheostomy. The charts of all patients who underwent tracheostomies in the burn unit between January 1990 and September 1993 were reviewed retrospectively. All tracheostomies were performed by residents in their second to fourth postgraduate years. The identical operating room technique was used for all bedside procedures including complete instrument tray, electrocautery, and adequate lighting. Standard tracheostomies were routinely performed at the bedside instead of the operating room in an attempt to deal with an increasing number of critically ill patients with burns requiring operating room surgical procedures. No patient-specific criteria were used to determine whether bedside or operating room tracheostomy would be performed. Charges for bedside intensive care unit and operating room tracheostomy were compared. Group t test and chi-square analysis were used with significance set at p < 0.05. Forty-three tracheostomies were performed in the 45-month period reviewed. Twenty-five tracheostomies performed in the operating room were compared with the 18 tracheostomies performed at the bedside in the burn intensive care unit. No statistical difference existed in age, sex, mean total body surface area percent burned, mean inspired oxygen, mean positive end expiratory pressure, mean pretracheostomy intubated days, presence of inhalation injury, or complication rate between groups. The average combined cost for operating room and anesthesia was $1740 per tracheostomy performed in the operating room. No charge was given to the patient for a bedside tracheostomy apart from the surgeon's fee and tracheostomy tube.(ABSTRACT TRUNCATED AT 250 WORDS)