Global predictors of tracheostomy-related pressure injury in the COVID-19 era: A study of secondary data.

ABSTRACT

OBJECTIVES: To determine the incidence and risk factors of tracheostomy-related pressure injuries (TRPI) and examine the COVID-19 pandemic's impact on TRPI incidence. DESIGN: Secondary analysis of Global Tracheostomy Collaborative database and a multi-center hospital system's electronic medical records. SETTING: 27 hospitals, primarily in the United States, United Kingdom, and Australasia. PATIENTS 6,400 adults and 2,405 pediatric patients hospitalized with tracheostomy between 1 January 2019 and 31 December 2021. MEASUREMENT TRPI as a binary outcome, reported as odds ratios. RESULTS: TRPI incidence was 4.69 % in adults and 5.65 % in children. For adults, associated risks were female sex (OR 0.64), severe obesity (OR 2.62), ICU admission (OR 2.05), cuffed tracheostomy (OR 1.49), fenestrated tracheostomy (OR 15.37), percutaneous insertion (OR 2.03) and COVID-19 infection (OR 1.66). For children, associated risks were diabetes mellitus (OR 4.31) and ICU admission (OR 2.68). TRPI odds increased rapidly in the first 60 days of stay. Age was positively associated with TRPI in adults (OR 1.014) and children (OR 1.060). Black patients had higher TRPI incidence than white patients; no moderating effects of race were found. Hospital cluster effects (adults ICC 0.227; children ICC 0.138) indicated unmeasured hospital-level factors played a significant role. CONCLUSIONS: Increasing age and length of stay up to 60 days are TRPI risk factors. Other risks for adults were female sex, severe obesity, cuffed/fenestrated tracheostomy, percutaneous insertion, and COVID-19; for children, diabetes mellitus and FlexTend devices were risks. Admission during the COVID-19 pandemic had contrasting effects for adults and children. Additional research is needed on unmeasured hospital-level factors. IMPLICATIONS FOR CLINICAL PRACTICE These findings can guide targeted interventions to reduce TRPI incidence and inform tracheostomy care during public health crises. Hospital benchmarking of tracheostomy-related pressure injuries is needed.