(Research Hub Theater) The Impact of Tracheostomy Weaning on Outcome and Care Costs in Patient with Prolonged Disorders for Consciousness (PDOC)

Background and/or Objectives:

Background: For patients in PDOC, tracheostomy decannulation is a common goal for rehabilitation. However, there is no published data on the association between decannulation and outcome (including ongoing costs of care) in this group.

Objective: To examine the outcomes for PDOC patients who are successfully decannulated.

Design: A multicentre national retrospective cohort analysis of prospectively collected data from the UK Rehabilitation Outcomes Collaborative (UKROC) clinical database.

Setting: UK national clinical database

Participants: Data were extracted for adults aged 16+ years, admitted for specialist rehabilitation between 2011-2022. Those in PDOC (n=2384) on admission were identified using previously published criteria.

Interventions: Specialist inpatient rehabilitation programmes including weaning if possible

Main Outcome Measures: The UK Functional Assessment Score (UKFIM+FAM). The Northwick Park Care Needs Assessment was used to estimate savings in ongoing costs of basic care

Results: 885/2384 (37%) patients had a tracheostomy on admission: Mean age 47 years, Males: Females 66:34%. Mean length of stay 140 days. Aetiology: Trauma 37%, Anoxia 25%, Stroke 26%, other 8%. 395 (51%) were successfully weaned during admission. Comparing Weaned vs Tracheostomised patients: 52% vs 19% had emerged from PDOC. Both groups remained severely disabled, but total FIM+FAM scores were significantly higher (Mean change 23.8 vs 2.9). Weaned patients stayed on average 17 days longer in rehabilitation, so that episode costs were higher (£86,948 vs 79,262). Nevertheless, the difference in mean weekly saving in basic care costs (£217) amounted to a mean group difference in net estimated lifetime savings of £320,736 per patient. Total net lifetime savings across the whole cohort (n=2384) were £198,189,072.

Conclusions: Ongoing tracheostomisation is likely a marker of severity, so savings in care costs cannot be attributed to decannulation alone. Nevertheless, our findings provide evidence that admission to specialist rehabilitation to explore the possibility of weaning provides overall value for money.