A36-17 Temporal Trends and Outcomes of Tracheostomy in Asthma Exacerbations: A Retrospective National Cohort, 2016-2022

Abstract Purpose To evaluate national trends, patient characteristics, and outcomes associated with open versus percutaneous tracheostomy in hospitalizations for asthma exacerbations between 2016 and 2022. Methods We performed a retrospective cohort analysis using the National Inpatient Sample (NIS) database. Adults hospitalized with asthma exacerbation between 2016 to 2022 were identified via ICD-10 codes and stratified by tracheostomy type. Primary outcomes included annual procedural trends, in-hospital mortality, length of stay (LOS), Consumer Price Index (CPI) -adjusted total hospital charges, and associated comorbidities. Between-group comparisons used Student’s t-test and Pearson’s χ² test; p-values 0. 05 were considered statistically significant. Results Of 625 patients hospitalized for asthma exacerbations requiring tracheostomy, 53. 6% underwent open and 46. 4% percutaneous procedures. In-hospital mortality was significantly higher in the open group (19. 4% vs. 5. 3%; p = 0. 026), which also had a higher prevalence of severe comorbidities (CCI ≥2: 65. 6% vs. 39. 7%; p = 0. 014). Temporal trends revealed a marked increase in open tracheostomy cases in 2021 (n = 70), coinciding with a peak in mortality (n = 40; p 0. 001). In contrast, percutaneous tracheostomy had no reported deaths in 2021 or 2022 (p 0. 001). The average length of hospital stay was similar between groups (open: 30. 88 days; percutaneous: 30. 36 days; p = 0. 896), with significant annual variation noted across both cohorts (p 0. 001). Total hospital charges were also comparable (open: 523, 166; percutaneous: 548, 391; p = 0. 804), peaking in 2019 for both groups (1, 087, 426 for open vs. 1, 338, 680 for percutaneous; p 0. 001). Conclusions Open tracheostomy in asthma exacerbations is associated with higher mortality and comorbidity burden compared to percutaneous approaches, suggesting that patients selected for open procedures are more critically ill. Clinical Implications Selection of tracheostomy type may reflect underlying illness severity. These findings underscore the importance of individualized procedural decision-making in severe asthma management. This abstract is funded by: None