Patients with severe COVID-19 infection who were intubated and had a tracheostomy had a significantly lower in-hospital mortality rate compared with those who did not have a tracheostomy, according to study results presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) 2022 Annual Meeting and OTO Experience, held in Philadelphia, Pennsylvania, September 10 to 14, 2022.

Researchers sought to assess the clinical benefit of tracheostomy, which is often indicated for patients needing prolonged intubation, for patients with severe COVID-19 infection. They therefore conducted a retrospective, multicenter, observational cohort study of patients with COVID-19 infection who were intubated while hospitalized at the University of Pennsylvania Health System, at locations in the Philadelphia area, during 2020 and 2021. The patients who received intubation alone were compared with those who were intubated and had a subsequent tracheostomy.

The study cohort included 777 patients (mean age, 62.2 ± 15.4 years; 58.2% male). Of these, 185 patients (23.8%) patients underwent a tracheostomy, with a mean time from endotracheal intubation to tracheostomy of 17.3 ± 9.7 days.

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Medical comorbidities were associated with having a tracheostomy, including being immunocompromised (odds ratio [OR], 5.2; P <.0001), currently smoking (OR, 3.3; P =.0034), having cardiovascular disease (OR, 2.2; P <.0001), and having diabetes mellitus (OR, 1.5; P =.0344). Tracheostomy was associated with a significantly longer hospital length of stay (57.5 ± 32.2 days vs 19.9 ± 18.1 days; P <.0001).

Notably, the study found patients who had a tracheostomy were significantly less likely to die during their hospitalization compared with those who did not undergo a tracheostomy (OR, 2.79; P <.0001).

“The difference in in-hospital mortality between COVID-19 patients who received intubation and those who received both intubation and tracheostomy suggests an association between tracheostomy and improved outcomes in the setting of severe COVID-19 infection,” concluded the study authors.


Alnemri A, Chao T, Ricciardelli K, Wang S. Tracheostomy is associated with decreased in-hospital mortality during severe COVID-19 infection. Abstract presented at: AAO-HNSF 2022 Annual Meeting and OTO Experience; September 10-14, 2022; Philadelphia, PA.