Tracheostomy Is Associated With Decreased In-Hospital Mortality During Severe COVID-19 Infection

ABSTRACT

Introduction: Tracheostomy is often performed in patients with a prolonged course of endotracheal intubation to minimize sedation, facilitate ventilator weaning, or to address other clinical complexities. However, the clinical benefit of tracheostomy during severe COVID-19 infection is not fully understood. Method(s) A retrospective single-system, multicenter observational cohort study was performed on patients intubated in the setting of COVID-19 infection in the University of Pennsylvania Health System during 2020 and 2021. Patients who received intubation alone were compared with patients who received intubation and subsequent tracheostomy. Data analyses included patient demographics, comorbidities, and hospital course. Result(s) Of 777 patients, 452 were male (58.2%) and 325 were female (41.8%) with a mean age of 62.2+/-15.4 years. A total of 185 (23.8%) patients underwent tracheostomy, and the mean time from endotracheal intubation to tracheostomy was 17.3+/-9.7 days. Medical comorbidities were associated with undergoing tracheostomy, including immunocompromise (odds ratio [OR]=5.2;P<.0001), current smoker (OR=3.3;P=.0034), cardiovascular disease (OR=2.2;P<.0001), and diabetes mellitus (OR=1.5;P=.0344). Tracheostomy was associated with a significantly longer hospital length of stay (57.5+/-32.2 days vs 19.9+/-18.1 days;P<.0001). However, patients who underwent tracheostomy were significantly less likely to expire during their hospitalization than those who did not undergo tracheostomy (OR=2.79;P<.0001). Conclusion(s) The difference in in-hospital mortality between COVID-19 patients who received intubation and those who received both intubation and tracheostomy suggests an association between tracheostomy and improved outcomes in the setting of severe COVID-19 infection.