Autor:
Dr.
Michaell Parra
E-mail:
michaelwparra@yahoo.com
Delray Beach, USA |
|
PERCUTANEOUS
DILATIONAL TRACHEOTOMY IN THE
CRITICALLY ILL TRAUMA PATIENT: A
RETROSPECTIVE COST COMPARISON STUDY |
Background
Analyze the complication
incidence, resource utilization and
cost-effectiveness between two methods of
tracheotomy: traditional open surgical (TOS)
versus percutaneous dilational tracheotomy
(PDT). Subjects: Retrospective-case paired
study at an Urban Level I Trauma Center. The
study population consisted of adult
(>18years of age) intubated trauma patients
in the trauma intensive care unit (TICU)
selected for tracheotomy placement between
October 2004 and June 2005. Main Outcome
Measures: Peri-operative complications,
comparison of procedural cost, and
utilization of hospital resources. METHODS:
Determination of procedural cost was
estimated upon review of surgical billing
and operating room material staff records.
An itemized cost list was retrospectively
developed for the typical PDT and the TOS.
For all TOS tracheotomies a full
OR/anesthesia team and necessary equipment
were utilized. For all PDT’s the procedure
was performed at bedside using a critical
care nurse, respiratory therapist, necessary
medications, and a commercially available
PDT kit.
Results
From October, 2004 to June, 2005
selected critical care trauma patients who
underwent bedside modified PDT were
paired-up respectively according to age,
injury severity score and length of ICU
stay; to those undergoing TOS. A total of
eight (8) patients had successfully
undergone PDT’s. The PDT group consisted of
7 men and 1 woman with a mean age of 44.4
+/- 20.7 years (range, 21-81 years). The
mean ISS score was 30.8 +/-11.0 (range,
17-41). The length of operation was 11.9
min. +/- 2.1 minutes for PDT’s and 21.1 min.
+/- 4.07 minutes for the open surgical
tracheotomies (p<0.0001). There was no peri-operative
complications associated with the PDT’s or
the TOS tracheotomies. The average cost
incurred by the hospital for the bedside PDT
was $260.00, while the average cost incurred
for the TOS was $1,045.00. Projecting these
results to 100 bedside tracheotomies, gives
us an institutional savings of approximately
$78,500.00 per 100 cases. A cost analysis
for PDT’s versus open surgical tracheotomies
is broken down in the following Table:
|
OST in OR |
PDT |
Anesthesia |
$273 |
$0 |
Pharmacy |
$22 |
$10 |
Tracheostomy Tube
|
$107 |
$107 |
PDT Kit |
$0 |
$143 |
OR cost |
$643 |
$0 |
Total
|
$1045 |
$260 |
OST=open surgical
tracheotomy; OR=operating room; PDT=percutaneous
dilational tracheotomy.
Conclusions
Total hospital cost incurred
was considerably less for those patients
that underwent the modified PDT. The PDT
required fewer hospital resources. The
incidence of complications was similar for
both procedures.
|