Comparison of tracheal resection outcomes at a university hospital vs county hospital setting

OBJECTIVES: To evaluate the role of hospital setting on outcomes in open airway surgery by comparing patients who underwent surgery (cricotracheal resection [CTR] or tracheal resection [TR]) at a publicly funded county hospital vs a private university hospital. METHODS: Retrospective chart review of patients undergoing CTR or TR at two institutions; a private university hospital and a publicly funded county hospital from September 2014 to September 2019. Length of intensive care unit (ICU) stay, total time to discharge, minor and major complications were the primary endpoints. Significance was defined as a P‐value less than .05. RESULTS: There were a total of 43 patients (17 county, 26 university) who had CTR or TR during the study period. Length of stay outcomes was reported as mean length of stay ± SD. There was a significant difference in ICU stay at the county hospital (7.17 (±5.36 days) compared to the university hospital (2.52 ± 1.85 days, P < .003) and a nearly significant total length of stay difference at the county hospital (12.4 ± 9.06 days) compared to the university hospital (7.84 ± 4 days, P < .072) There was overall a low incidence of complications but slightly more in the county compared to the university population. CONCLUSION: Patients who underwent open airway surgery at the county hospital were more likely to have a longer ICU stay and slight increase in complications despite having a lower ASA (American Society of Anesthesiologists) classification and younger age. These outcomes are multifactorial and may be related to poorer access to primary care preoperatively leading to delay in diagnosis and treatment, poorly controlled or undiagnosed medical comorbidities, and differences in hospital resources. LEVEL OF EVIDENCE: IV.