Oded Cohen1,2, Yael Shapira-Galitz3,4, Ruth Shnipper4, Dekel Stavi5,6, Doron Halperin3,4, Nimrod Adi5,6, Yonatan Lahav3,4. 1. Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, POB 1, 76100, Rehovot, Israel. odedco@clalit.org.il. 2. Hebrew University- Hadassah Medical School, Jerusalem, Israel. odedco@clalit.org.il. 3. Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, POB 1, 76100, Rehovot, Israel. 4. Hebrew University- Hadassah Medical School, Jerusalem, Israel. 5. Intensive Care Unit, Kaplan Medical Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel. 6. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Abstract
PURPOSE: To evaluate percutaneous dilatational tracheostomy in patients ≥ 85 years old: its complication rate and possible risk factors. In addition, to assess prognostic factors for short, intermediate and long term survival following the procedure. METHODS: A retrospective case-control study of 72 patients ≥ 85 years who received percutaneous dilatation tracheotomy (PTD), compared to a control group of younger patients (n = 182). Demographics, clinical and laboratory data were collected. Survival and risk for complications were analyzed. RESULTS: The study group's mean age was 89 ± 4. Twelve patients had complications, three (4.2%) were major. No significant difference was found in overall complication rates between the groups. Cerebrovascular disease with neurologic deficits and pre-procedure albumin levels were significantly associated with complications. Survival rates did not differ in 1 week and 1 month following procedure between study and control group. There was a significant difference in the 1-year survival rates between the patients ≥ 85 years and the control groups (18.1% vs. 34.4%, p = 0.01, respectively). Congestive heart failure, a frailty score > 0.27 and failure to wean from a cannula were associated with reduced 1-year survival. CONCLUSION: PTD is safe for patients ≥ 85 years. Complication risk factors and reduced survival should be discussed with patients and families before conducting tracheostomies. LEVEL OF EVIDENCE: 3b.
PURPOSE: To evaluate percutaneous dilatational tracheostomy in patients ≥ 85 years old: its complication rate and possible risk factors. In addition, to assess prognostic factors for short, intermediate and long term survival following the procedure. METHODS: A retrospective case-control study of 72 patients ≥ 85 years who received percutaneous dilatation tracheotomy (PTD), compared to a control group of younger patients (n = 182). Demographics, clinical and laboratory data were collected. Survival and risk for complications were analyzed. RESULTS: The study group's mean age was 89 ± 4. Twelve patients had complications, three (4.2%) were major. No significant difference was found in overall complication rates between the groups. Cerebrovascular disease with neurologic deficits and pre-procedure albumin levels were significantly associated with complications. Survival rates did not differ in 1 week and 1 month following procedure between study and control group. There was a significant difference in the 1-year survival rates between the patients ≥ 85 years and the control groups (18.1% vs. 34.4%, p = 0.01, respectively). Congestive heart failure, a frailty score > 0.27 and failure to wean from a cannula were associated with reduced 1-year survival. CONCLUSION: PTD is safe for patients ≥ 85 years. Complication risk factors and reduced survival should be discussed with patients and families before conducting tracheostomies. LEVEL OF EVIDENCE: 3b.
Entities:
Keywords:
Complications; Oldest of old; Percutaneous; Prognosis; Survival; Tracheostomy
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