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Outcome and survival following tracheostomy in patients ≥ 85 years old

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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.

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Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, POB 1, 76100, Rehovot, Israel

    Oded Cohen, Yael Shapira-Galitz, Doron Halperin & Yonatan Lahav

  2. Hebrew University- Hadassah Medical School, Jerusalem, Israel

    Oded Cohen, Yael Shapira-Galitz, Ruth Shnipper, Doron Halperin & Yonatan Lahav

  3. Intensive Care Unit, Kaplan Medical Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel

    Dekel Stavi & Nimrod Adi

  4. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Dekel Stavi & Nimrod Adi

Authors
  1. Oded Cohen
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  2. Yael Shapira-Galitz
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  3. Ruth Shnipper
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  4. Dekel Stavi
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  5. Doron Halperin
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  7. Yonatan Lahav
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Correspondence to Oded Cohen.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Kaplan Medical Center's Review Board and Ethical Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards”.

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This article does not contain any studies with human participants performed by any of the authors.

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Informed consent was not obtained due to the anonymous retrospective data collection and analysis, as approved by the institutional ethical committee.

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Cohen, O., Shapira-Galitz, Y., Shnipper, R. et al. Outcome and survival following tracheostomy in patients ≥ 85 years old. Eur Arch Otorhinolaryngol 276, 1837–1844 (2019). https://doi.org/10.1007/s00405-019-05447-z

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  • DOI: https://doi.org/10.1007/s00405-019-05447-z

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