Open versus percutaneous dilatational tracheostomy: Efficacy and cost analysis

The economic advantages of percutaneous dilatational tracheostomies versus open tracheostomies in the operating room have been thoroughly evaluated. W e are now reporting our comparison of the costs and charges of percutaneous dilatational tracheostomies with those of open bedside tracheostomies at o ur institution. The current literature comparing the two open techniques an d the percutaneous method of placing tracheostomies was reviewed and the ch arges and costs for these procedures at our institution were compared. Pati ents were placed into one of three groups for analysis: open tracheostomies in the operating room (Group I), open tracheostomies in the intensive care unit (Group II), and percutaneous dilatational tracheostomies in the inten sive care unit (Group Ill). Based on our own experience and a literature re view it is evident that all three approaches to tracheostomies are safe. Ec onomic analysis showed a savings of $180 in cost per procedure and a $658 s avings in charges per procedure for the open method at the bedside when com pared with the percutaneous method at the bedside. The professional fee for bronchoscopy was not included in this calculation; including this would le ad to greater savings with the open method over the percutaneous method. Op en tracheostomy in the operating room increased costs over the bedside proc edure by $2194 and increased charges by $2871. For the 150 to 180 tracheost omies done each year at our institution utilization of the open technique a t the bedside results in a cost savings of approximately $31,500 and a char ge savings of $109,000 compared with the percutaneous dilatational tracheos tomy. Both the open bedside and percutaneous dilatational methods are reaso nable and safe options, However, the open bedside tracheostomy is a better utilization of resources and is more cost effective, and it is the procedur e of choice at our institution.