Influence of Surgeon Specialty on Tracheostomy Outcomes

Introduction: Tracheostomy is a commonly performed procedure across multiple surgical specialties in which an opening is made in the trachea to establish an airway for breathing support. This study investigates how provider specialty, specifically otolaryngologists (ENTs) versus general surgeons, influences tracheostomy outcomes.

Methods: This retrospective study used the National Surgical Quality Improvement Program (NSQIP) database to identify patients undergoing tracheostomy from 2005 to 2018, stratified by surgeon specialty. Our study included patients with various conditions requiring tracheostomy in hospital settings. Baseline characteristics and outcomes were compared using univariate analyses. Multivariable analyses adjusted for patient demographics and comorbidities. Primary outcomes included prolonged ventilation, reintubation, mortality, and hospital length of stay, while secondary outcomes were 30-day readmission, sepsis, and pneumonia. Statistical significance was set at p< 0.05.

Results: We identified 4,488 tracheostomy patients, with 3,428 (76.4%) operated on by ENTs, 573 (12.8%) by general surgeons, and 487 (10.9%) by other specialists. ENT patients were more likely to be white, male, and have higher ASA classification (p < 0.001). Univariate analysis showed ENT patients were less likely to require prolonged ventilation (6.9% vs. 47.6%, p< 0.001) and had lower rates of sepsis (4.2% vs. 12.2%, p< 0.001), mortality (0.9% vs. 13.3%, p< 0.001), and shorter hospital stays (11.12 vs. 26.02 days, p< 0.001). Multivariable analysis found general surgery patients twice as likely to require reintubation (OR 2.148, p=0.007), with no significant differences in readmission or pneumonia.

Conclusions: Tracheostomies performed by ENT surgeons were associated with fewer adverse events, including lower rates of reintubation, sepsis, and mortality, as well as shorter hospital stays compared to general surgeons, while 30-day readmission rates were similar. These findings highlight the importance of specialty-specific expertise in improving outcomes.