Predictors of Mortality in Patients With COVID-19 Undergoing Tracheotomy

Objective: To identify factors predictive of 30-day mortality following tracheotomy in patients with COVID-19. Methods: A retrospective chart review of patients with COVID-19 who underwent tracheotomy at a tertiary medical center between March 2020 and October 2021 was conducted. Univariate and multivariable analyses of factors correlated with 30-day post-tracheotomy mortality were performed. The outcomes of tracheotomies performed in the operating room and at bedside were compared with t-tests and multivariable analysis. Results: One hundred-twenty patients met inclusion criteria, with 48 female patients (40%). Mean age was 59.8 [12.6] years, and the 30-day mortality rate was 18.3%. On univariate analysis, age (odds ratio (OR) = 1.06; P =.015), FiO₂ at the time of tracheotomy (OR = 1.06; P <.001), and bedside tracheotomy (OR = 3.21; P =.019) were associated with increased risk of 30-day mortality. After including control variables, increased FiO₂ continued to predict increased odds of 30-day mortality (OR = 1.08; P =.02); specifically, patients with FiO₂ > 65% were significantly more likely to pass within 30 days than those with FiO₂ ≤ 40% (OR = 28.24; P <.001). There was a significant difference in the 30-day mortality rate of bedside tracheotomies (31%) and OR tracheotomies (12%; P =.02), but this association was eliminated on multivariable analysis (OR = 0.95; P =.96). Conclusion: Intubated patients with COVID-19 undergoing tracheotomy with FiO₂ > 65% have 25 times greater odds of 30-day mortality than those with FiO₂ ≤ 40%. There were no differences in outcomes between bedside and OR tracheotomies.