Impact of COVID on tracheotomy practices

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID) can cause respiratory distress, which can lead to intubation and even tracheotomy. With the risk of viral aerosolization, tracheotomy practices were directly affected by the COVID pandemic. Our study analyzes these practices at the pandemic's inception. Method: This was a single-institution retrospective study that included patients undergoing tracheotomy from December 2019 to June 2020. Patients were divided into 2 groups pre- COVID (December 2019-March 2020) and post-COVID (March 2020-June 2020). Data were collected from the electronic medical record. Statistical analyses were done via 2-tailed independent t tests and Fisher exact tests. Results: There were 42 patients in the pre-COVID group and 25 patients in the post-COVID group. None of the patients were COVID positive. The main indication for tracheotomy in both groups was prolonged intubation followed by adjunct to head and neck surgery. Before the pandemic, otolaryngology performed 36% of tracheotomies, followed by thoracic surgery (29%) and trauma (26%). After the start of the pandemic, trauma performed 40% of tracheotomies, followed by otolaryngology (28%) and thoracic surgery (28%). This shift in departments was not significant (P = .62). There was a significant increase in the percentage of tracheotomies performed in the operating room (OR;P = .04). In the pre- and post-COVID cohorts, 57% and 64% of tracheotomies were performed open, respectively (P = .62). For patients undergoing tracheotomy for prolonged intubation, the means and ranges for time to tracheotomy in the pre- and post-COVID groups were 18 (4-40) and 20 (3-42) days, respectively (P = .55). There was no significant difference in overall length of stay (P = .77) or length of mechanical ventilation (P = .56) between the 2 groups. Conclusion: At the start of the pandemic, there was a significant increase in tracheotomies performed in the OR, likely to limit viral spread, despite all patients being COVID negative. Although not significant, there was a trend toward performing more open tracheotomies. It is important to note that these data were collected early in the pandemic and additional trends may become apparent over time.