Abstract
Objectives: We aimed to characterise the use of tracheostomy
procedures for all COVID-19 critical care patients in England and to
understand how patient factors and timing of tracheostomy affected
outcomes.
Design: A retrospective observational study using exploratory
analysis of hospital administrative data.
Setting: All 500 National Health Service hospitals in England.
Participants: All hospitalised COVID-19 patients aged ≥ 18
years in England between March 1st and October
31st, 2020 were included.
Main outcomes and measures: This was a retrospective
exploratory analysis using the Hospital Episode Statistics
administrative dataset. Multilevel modelling was used to explore the
relationship between demographic factors, comorbidity and use of
tracheostomy and the association between tracheostomy use, tracheostomy
timing and the outcomes.
Results: In total, 2,200 hospitalised COVID-19 patients had a
tracheostomy. Tracheostomy utilisation varied across the study period,
peaking in April-June 2020. In multivariable modelling, for those
admitted to critical care, tracheostomy was most common in those aged
40-79 years, in males and in people of Black and Asian ethnic groups and
those with a history of cerebrovascular disease. In critical care
patients, tracheostomy was associated with lower odds of mortality (OR:
0.514 (95% CI 0.443 to 0.596), but greater length of stay (OR: 41.143
(95% CI 30.979 to 54.642). In patients that survived, earlier timing of
tracheostomy (≤ 14 days post admission to critical care) was
significantly associated with shorter length of stay.
Conclusions: Tracheostomy is safe and advantageous for critical
care COVID-19 patients. Early tracheostomy may be associated with better
outcomes, such as shorter length of stay, compared to late tracheostomy.
Key words: tracheostomy, COVID-19, SARS-CoV2, intubation,
mechanical ventilation