Demographic and Clinical Trends in Adult Tracheostomy: Analysis of a Japanese Inpatient Database.

Abstract

To analyze demographics, underlying diseases, and clinical outcomes of adult patients undergoing tracheostomy over 6 years, identifying annual changes and significant trends. This study is a descriptive analysis of a retrospective cohort. Data were obtained from the Diagnosis Procedure Combination inpatient database in Japan between January 2016 and December 2021. Adult patients (≥ 20 years) who underwent tracheostomy were included, excluding those from facilities inconsistently included in the database. Trends in demographics, underlying diseases, Charlson Comorbidity Index scores, departments performing tracheostomies, intensive care unit (ICU) admissions, body mass index at admission, hospital stay duration, timing of mechanical ventilation initiation, and discharge routes were analyzed. A total of 22,480 patients were included (66.0% men; median age, 73 years). Respiratory diseases (36.6%) were the most common condition, followed by neurological diseases (29.4%), cardiovascular diseases (21.2%), and cancer and benign tumors (19.9%). The median hospital stay was 56 days, which slightly decreased to 53 days in 2021. Transfers to other hospitals increased from 51.0% in 2016 to 55.9% in 2021. Among 10,499 patients requiring ICU ventilatory management, 2756 (26.3%) underwent tracheostomy within 7 days of initiating mechanical ventilation, with no significant increase in early tracheostomy rates over the study period. The study highlights that respiratory diseases are the leading indication for tracheostomy in adults. The majority of tracheostomies were performed after the initiation of mechanical ventilation, underscoring prolonged ventilation as a primary indication. Further research is warranted to optimize guidelines for tracheostomy timing and indications in adult patients.