Cost analysis of intubation-related tracheal injury using a national database

Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Otolaryngology Head and Neck Surgery (Impact Factor: 2.02). 07/2010; 143(1):31-6. DOI: 10.1016/j.otohns.2009.11.004
Source: PubMed


To perform risk analysis of tracheal injuries caused by endotracheal intubation (ETI) and to estimate the financial impact of these sequelae.
Cost analysis using a national database.
The Agency for Healthcare Research and Quality (AHRQ) 2006 National Inpatient Sample.
We identified clinical manifestations and treatments of complications associated with endotracheal tubes and codified them into International Classification of Disease-ninth revision diagnosis and procedure codes, intentionally excluding alternative etiologies of tracheal injury. Using the AHRQ 2006 National Inpatient Sample, we then compared patients with tracheal injury coded during the medical or surgical stay for length of stay (LOS) and mean hospital cost with diagnosis-related group (DRG)-matched controls; we also examined readmissions treating tracheal injury.
Tracheal injury presents as tracheal stenosis, tracheomalacia, tracheoesophageal fistula, laryngotracheal ulceration, and vocal cord paralysis. A total of 3232 discharge records met criteria for tracheal injury from ETI within the index hospital stay. Average LOS for patients with tracheal injury (6.3 days; 95% confidence interval [CI] 6.0-6.3) exceeded LOS in the uncomplicated sample (5.2 days; CI 5.1-5.3) by 1.1 days. The average hospital cost was $1888 higher with tracheal injury ($10,375 [CI $9762-$10,988] vs $8487 [CI $8266-$8669]). LOS for procedures treating prior tracheal injury averaged 4.7 days and cost an average of $11,025 per discharge.
Tracheal injury from ETI is associated with a significant increase in healthcare costs that accrue both during the index admission and during subsequent hospitalizations required to treat the injury.

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    • "Despite the lack of evidence of benefit from an early tracheostomy (Gomes-Silva et al., 2012), mechanical ventilation is the most common reason for tracheostomy in the intensive care. Prolonged tracheal intubation by endotracheal tube increases the risk of oral and upper airway damage including tracheal stenosis and vocal cord palsy (Bhatti et al., 2010). It is generally accepted that endotracheal intubation requires a greater reliance on sedation than tracheal intubation; higher levels of sedation; increased time to extubation and mobilization ; and active cognitive engagement by the patient (Schweickert et al., 2009). "
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