Cost analysis of early vs late trachestomy in intensive care settings
CCCF ePoster library. Herritt B. Oct 3, 2017; 198131; 51
Dr. Brent Herritt
Dr. Brent Herritt
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Cost analysis of early vs late trachestomy in intensive care settings

Herritt, Brent1; Chaudhuri, Dipayan1; Kyeremanteng, Kwadwo2

1 Department of Internal Medicine,The Ottawa Hospital, Ottawa, Canada

2 Department of Critical Care, The Ottawa Hospital, Ottawa, Canada

INTRODUCTION: Up to 12% of the 800 000 patients who undergo mechanical ventilation in the United States every year require tracheostomies. A recent systematic review conducted by Hosokawa et al showed that early tracheostomy was associated with better outcomes: more ventilator-free days, shorter ICU stays, less sedation and reduced long-term mortality. However, no cost-analysis on the timing of early tracheostomies have been conducted.
OBJECTIVES: To conduct a cost-analysis on the timing of tracheostomy in mechanically ventilated patients
METHODS:  We collected individual length of hospital stay and length of ICU stay data from the studies included in the systematic review from Hosokawa et al. We also searched for any recent randomized control trials on the topic that were published after this review. Average daily hospital and ICU costs per patients were obtained from a cost model by Kahn et al. We estimated hospital and ICU costs by multiplying LOS with respective average daily cost per patient. We calculated difference in costs by subtracting hospital costs, ICU costs and total direct variable costs from early tracheotomy to late tracheotomy. 95% confidence intervals were estimated using bootstrap re-sampling procedures with 1000 iterations. 
RESULTS: The average weighted cost of ICU stay in patients with an early tracheostomy was $ 5 063 less when compared to patients with late tracheostomy (95% CI: 355 - 9770, I= 89.8%). This was calculated using a random effects model. A sensitivity analysis shows consistent cost reductions even with longer LOS in the early tracheostomy group. Subgroup analysis revealed that very early tracheostomies (less than 4 days) cost on average $4492 USD less than late tracheostomies (95% CI: -1309 - 10294, I2= 94.1%) and that early tracheostomies (less than 10 days but greater than 4) cost on average $6385 USD less than late tracheostomies (95% CI: - 4396 - 17165, I2 = 70.0%)
CONCLUSION: This study shows that early tracheostomy can significantly reduce direct variable and likely total costs in the intensive care unit based on length of stay alone. This is in addition to the already shown benefits of early tracheostomy in terms of ventilator dependent days, reduced length of stays, decreased pain, and improved communication. Further prospective studies on this topic are needed to definitely prove the cost-effectiveness of early tracheostomy in the critically ill population.

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