Tracheostomy in COVID-19: A retrospective cohort study of outcomes and mortality predictors in a specialized infectious disease hospital in Brazil

PMCID: PMC12176168

PMID: 40531975

DOI: 10.1371/journal.pone.0326531

Journal: PloS one

Publication Date: 2025-6-18

Authors: Accetta AF, Medeiros DM, Diniz Ribeiro MP, Cardoso SW, Ferreira Tavares IC, et al.

Key Points

• 68% mortality rate among COVID-19 patients undergoing tracheostomy, emphasizing the severity of respiratory complications
• Patients over 60 with chronic pulmonary disease and diabetes have nearly 3-6 times higher mortality risk
• Vaccination status and patient physiological parameters at surgery are more critical in predicting outcomes than mechanical ventilation duration

Summary

This retrospective cohort study investigated prognostic factors associated with mortality among COVID-19 patients undergoing tracheostomy for respiratory failure in a Brazilian infectious disease hospital. Out of 356 patients who underwent tracheostomy, a significant 68% mortality rate was observed, highlighting the critical nature of COVID-19 respiratory complications. The research meticulously analyzed demographic, clinical, and surgical factors to identify independent predictors of hospital mortality.

Multivariate logistic regression revealed several key independent factors associated with increased mortality risk: age over 60 years (OR 2.72), chronic pulmonary disease (OR 6.36), diabetes (OR 2.90), lack of COVID-19 vaccination (OR 1.53), hemodialysis on the day of surgery (OR 4.11), and a PaO2/FiO2 ratio lower than 200 on the surgery day (OR 2.44). Notably, the timing of tracheostomy (after 21 days of mechanical ventilation) was not significantly associated with mortality, challenging previous assumptions about optimal tracheostomy timing.