Utilisation of tracheostomy in patients with COVID‐19 in England: Patient characteristics, timing and outcomes

Abstract

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. A retrospective observational study using exploratory analysis of hospital administrative data. All 500National Health Service hospitals in England. All hospitalised COVID-19 patients aged ≥18years in England between 1March and 31 October 2020 were included. This was a retrospective exploratory analysis using the Hospital Episode Statistics administrative data set. 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. In total, 2200hospitalised 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 40-79years, 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 (≤14days post admission to critical care) was significantly associated with shorter length of stay. 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.