Hospital Variation in Early Tracheostomy in the United States: A Population-Based Study*

Objective: Controversy exists regarding perceived benefits of early tracheostomy to facilitate weaning among mechanically ventilated patients, potentially leading to significant practice-pattern variation with implications for outcomes and resource utilization. We sought to determine practice-pattern variation and outcomes associated with tracheostomy timing in the United States. Design: In a retrospective cohort study, we identified mechanically ventilated patients with the most common causes of respiratory failure leading to tracheostomy: pneumonia/sepsis and trauma. “Early tracheostomy” was performed within the first week of mechanical ventilation. We determined between-hospital variation in early tracheostomy utilization and the association of early tracheostomy with patient outcomes using hierarchical regression. Setting: 2012 National Inpatient Sample. Patients: A total of 6,075 pneumonia/sepsis patients and 12,030 trauma patients with tracheostomy. Interventions: None. Measurements and Main Results: Trauma patients were twice as likely as pneumonia/sepsis patients to receive early tracheostomy (44.5% vs 21.7%; p

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