Rutgers New Jersey Medical School Woodbridge, New Jersey
Educational Objective: At the conclusion of this presentation, the participants should be able to consider whether transfer status impacts postoperative complications in adult patients who receive tracheostomies.
Objectives: Patients transferred in from entry points of care typically have complex comorbidities and complications that require greater management. However, the impact of transfer status has not been examined in adult tracheostomy patients. Our study seeks to determine whether transfer status predicts postoperative outcomes following tracheostomy.
Study Design: Retrospective database review.
Methods: The National Surgical Quality Improvement Program database was queried for adult patients with known transfer status who underwent tracheostomy between 2005 and 2018. Multivariate analyses were conducted to investigate the association between transfer status and postoperative comorbidities and complications.
Results: 4,469 patients were included. The mean age was 60.9 years. 336 patients (7.5%) were transferred in and 70.8% experienced any complication compared to 48.1% of directly admitted patients (p < 0.001). Univariate analysis also showed that transferred patients were likelier to experience postoperative superficial surgical site infection (SSI) (p < 0.001), pneumonia (p < 0.001), extended ventilator dependence (EVD) (p < 0.001), acute renal failure (p < 0.001), urinary tract infection (p < 0.001), cardiac arrest (p = 0.018), sepsis (p < 0.001), and septic shock (p < 0.001). Multivariate analysis controlling for age, race, sex, ASA status, and significant comorbidities and complications associated transfer status with reduced likelihood of SSI (OR 0.237, 95% CI 0.083 - 0.676, p = 0.007) and increased likelihood of EVD (OR 1.664, 95% CI 1.157 - 2.395, p = 0.006).
Conclusions: This study found an association between transfer status and specific complications. Transferred patients undergoing tracheostomy have more complications, though transfer status does not impact postoperative outcomes for mortality.