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Utilisation of tracheostomy in patients with COVID-19 in England: patient characteristics, timing and outcomes
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  • Annakan Navaratnam,
  • William Gray,
  • Josh Wall,
  • Arun Takhar,
  • Taran Tatla,
  • Jamie Day,
  • Anna Batchelor,
  • Michael Swart ,
  • Christopher Snowden ,
  • Andrew Marshall,
  • Tim Briggs
Annakan Navaratnam
Royal National Throat Nose and Ear Hospital
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William Gray
NHS England
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Josh Wall
NHS England
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Arun Takhar
Guy's and St Thomas' NHS Foundation Trust
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Taran Tatla
Northwick Park Hospital
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Jamie Day
NHS England
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Anna Batchelor
NHS England
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Michael Swart
NHS England
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Christopher Snowden
NHS England
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Andrew Marshall
Queen's Medical Centre
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Tim Briggs
NHS England
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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 substantially 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.
10 Nov 2021Submitted to Clinical Otolaryngology
19 Nov 2021Assigned to Editor
19 Nov 2021Submission Checks Completed
07 Dec 2021Reviewer(s) Assigned
12 Jan 2022Review(s) Completed, Editorial Evaluation Pending
15 Jan 2022Editorial Decision: Accept
03 Feb 2022Published in Clinical Otolaryngology. 10.1111/coa.13913