HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leonard N. Girardi Charles A. Mack Wilson Ko Anthony J. Tortolani Karl H. Krieger O. Wayne Isom Leonard Y. Lee Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bacchetta, M. D. Articles by Lee, L. Y. Search for Related Content PubMed PubMed Citation Articles by Bacchetta, M. D. Articles by Lee, L. Y. Related Collections Trachea and bronchi

Ann Thorac Surg 2005;79:1879-1885
© 2005 The Society of Thoracic Surgeons

---

Original article: General thoracic

Comparison of Open Versus Bedside Percutaneous Dilatational Tracheostomy in the Cardiothoracic Surgical Patient: Outcomes and Financial Analysis

Department of Cardiothoracic Surgery, New York Presbyterian Hospital—Cornell University, New York, New York

Accepted for publication October 22, 2004.

^_* Address reprint requests to Dr Lee, Dept of Cardiothoracic Surgery, New York Presbyterian Hospital—Cornell University, 525 East 68th St, M-4, New York, NY 10021 (E-mail: lyl2003{at}med.cornell.edu).

BACKGROUND: The clinical and financial outcomes of a change in practice from traditional tracheostomy (open) to bedside percutaneous dilatational tracheostomies (PDT) was evaluated in patients who underwent cardiothoracic surgery.

METHODS: During 3 years, 86 tracheostomies were performed in more than 4,000 patients who underwent cardiac surgery, 59 open and 27 PDT. A retrospective analysis was performed comparing clinical and financial outcomes of the two groups.

RESULTS: There were no significant differences in demographics, medical histories, operations, or complications between open and PDT except the open group experienced more postoperative arrhythmias (70% [41 of 59] versus 44% [12 of 27], p < 0.05). Total savings associated with 1 year of PDT was $84,000, for a projected discounted savings of $283,000 during the study period. A sensitivity analysis of critical economic variables (number of tracheostomies per year, cost of operating room per minute, cost of intensive care unit bed per day) was included to evaluate the impact on cost savings. The net present value analysis, which discounts future savings by an appropriate interest rate, yielded a range of projected savings of PDT more than 5 years of $73,000 to $541,000 with a best estimate of $304,000 using figures established from our 3-year experience with PDT. Sensitivity analysis of the net present value for each critical variable was $227,000 per day of reduced intensive care unit length of stay, $180,000 per cost of operating room avoidance, $100,000 per intensive care unit bed cost per day, and $11,000 per additional tracheostomy per year.

CONCLUSIONS: There were no significant clinical differences between open and PDT in cardiac surgery patients during the 3-year study period; however, PDT offered significant cost savings.

This article has been cited by other articles:

				T. W. Gromann, O. Birkelbach, and R. Hetzer Balloon Dilatational Tracheostomy: Initial Experience with the Ciaglia Blue Dolphin Method Anesth. Analg., June 1, 2009; 108(6): 1862 - 1866. [Abstract] [Full Text] [PDF]

				C. P. Williams, M. J. Rosen, J. Jin, M. F. McGee, S. J. Schomisch, and J. Ponsky Objective Analysis of the Accuracy and Efficacy of a Novel Fascial Closure Device Surgical Innovation, December 1, 2008; 15(4): 307 - 311. [Abstract] [PDF]

				S. Nundy, A. Mukherjee, J. B. Sexton, P. J. Pronovost, A. Knight, L. C. Rowen, M. Duncan, D. Syin, and M. A. Makary Impact of Preoperative Briefings on Operating Room Delays: A Preliminary Report Arch Surg, November 1, 2008; 143(11): 1068 - 1072. [Abstract] [Full Text] [PDF]

				D. L. Ngaage, A. R. Cale, S. Griffin, L. Guvendik, and M. E. Cowen Is post-sternotomy percutaneous dilatational tracheostomy a predictor for sternal wound infections? Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1076 - 1079. [Abstract] [Full Text] [PDF]

				P. B. Rahmanian, D. H. Adams, J. G. Castillo, J. Chikwe, and F. Filsoufi Tracheostomy is Not a Risk Factor for Deep Sternal Wound Infection After Cardiac Surgery Ann. Thorac. Surg., December 1, 2007; 84(6): 1984 - 1991. [Abstract] [Full Text] [PDF]

				P. De Leyn, L. Bedert, M. Delcroix, P. Depuydt, G. Lauwers, Y. Sokolov, A. Van Meerhaeghe, and P. Van Schil Tracheotomy: clinical review and guidelines Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 412 - 421. [Abstract] [Full Text] [PDF]