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Observational Study
. 2022 Jun;279(6):3095-3103.
doi: 10.1007/s00405-021-07120-w. Epub 2021 Oct 12.

Outcomes and survival of tracheostomised patients during the COVID-19 pandemic in a third level hospital

Marta Mesalles-Ruiz  1   2 , Miriam Hamdan  3 , Gabriel Huguet-Llull  3   4 , Anna Penella  3 , Alejandro Portillo  3 , Eva Bagudà  3 , Marta Capelleras  3 , José Maria Caballero  3 , Mireia Golet  3 , Marta Fulla  3   4 , Ricardo Bartel  3   4 , Enric Cisa  3 , Francesc Cruellas  3 , Jordi Tornero  3 , Henry Rafael Lares  3 , Anna Farré  3 , Javier Skufca  3 , Julio Nogués  3 , Manuel Mañós  3   4 , Xavier Gonzàlez-Compta  3   4
Affiliations
Observational Study

Outcomes and survival of tracheostomised patients during the COVID-19 pandemic in a third level hospital

Marta Mesalles-Ruiz et al. Eur Arch Otorhinolaryngol. 2022 Jun.

Abstract

Purpose: Analyse the evolution and outcomes of COVID-19 tracheostomised patients. Clarify if this cohort presents an increased risk of haemorrhagic complications and verify the correlation between some risk factors with increased mortality.

Methods: A retrospective single-centre observational study of a prospective cohort of all COVID-19 patients admitted to our centre between March and April 2020. A control group was obtained from a historical cohort of patients who required tracheostomy due to prolonged invasive mechanical ventilation (IMV) before 2020.

Results: A total of 1768 patients were included: 67 tracheostomised non-COVID-19 patients (historic cohort), 1371 COVID-19 patients that did not require ICU admission, 266 non-tracheostomised COVID-19 patients and 64 tracheostomised COVID-19 patients. Comparing the obesity prevalence, 54.69% of the tracheostomised COVID-19 patients were obese and 10.53% of the non-tracheostomised COVID-19 patients (p < 0.001). The median of ICU admission days was lower (p < 0.001) in the non-tracheostomised cohort (12.5 days) compared with the COVID-19 tracheostomised cohort (34 days). The incidence of haemorrhagic complications was significantly higher in tracheostomised COVID-19 patients (20.31%) compared with tracheostomised non-COVID-19 patients (5.97%) and presented a higher percentage of obesity, hypertension, diabetes and smoking, significantly different from the historic cohort (p < 0.001). A Cox model showed that tracheostomy had no statistically significant effect on mortality in COVID-19 patients.

Conclusion: Obesity and smoking may be risk factors for tracheostomy in COVID-19 patients, tracheostomised COVID-19 patients present a higher risk of bleeding complications than those admitted for other reasons and an elevated LDH and INR on ICU admission may be associated with increased mortality.

Keywords: COVID-19; Haemorrhagic complications; Obesity; Smoking; Tracheostomy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Kaplan–Meier estimator according to tracheostomy moment
Fig. 3
Fig. 3
Kaplan–Meier survival estimator of COVID-19 tracheostomised patients survival
Fig. 4
Fig. 4
Kaplan–Meier survival estimator of COVID-19 tracheostomised patients survival compared to an historic cohort
See this image and copyright information in PMC

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