Mortality, complications and hospital length of stay in percutaneous vs. open tracheostomy. A retrospective study

Introduction: Tracheostomy is a procedure commonly performed in critically ill patients, using one of two techniques: open (OT) or percutaneous (PT). PT is performed in the intensive care unit (ICU) by intensive care physicians, while OT is performed in the operating room by otolanryngologists or surgeons. Objective: To determine if there are any differences in mortality, complications or hospital length of stay between the two techniques. Methods: Descriptive retrospective cohort study in adult patients undergoing tracheostomy, hospitalized in an ICU of a Level III hospital in Antioquia between January 1, 2020 and December 31, 2022. Results: The study evaluated the clinical records of 116 patients who met the inclusion criteria, 84 with PT and 32 with OT. Overall mortality was 44%, with no significant differences found between the two groups (OT 43.8% and PT 44%), or when controlling for other variables (OR = 0.848, 95% CI: 0.35-2.02); there were no procedure-related deaths. No differences were found in the percentage of hospitalization complications by tracheostomy type. Differences were found in terms of duration of orotracheal intubation: OT 18 (15-21) days and PT 12 (8-15) days (p < 0.001); mechanical ventilation: OT 32 (22-36) days and PT 23 (15-38) days (p = 0.046); and ICU length of stay: OT 36 (27-43) days and PT 28 (18-41) days (p = 0.038). Conclusions: Performance of PT in the ICU was not associated with increased mortality or major complications when compared to OT; moreover, it was associated with shorter duration of orotracheal intubation and mechanical ventilation, as well as ICU length of stay.