Efficacy of home healthcare on the management of tracheostomy patients

Nura A. Almansour; Yasmeen A. AlHedyan; Nada N. Alshathri; Razan S. Alsubaie; Sara Y. Alsuliman; Aamir A. Omair; Abdullah K. Alanazi; Amjad S. Alserayaa

doi:10.15537/smj.2024.45.7.20240294

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Table 1

- Basic demographic characteristics of the patients (N=183).

Study data	n (%)
Age group
18 – 40 years	34 (19%)
41 – 60 years	24 (13%)
61 – 70 years	34 (19%)
71 – 80 years	48 (26%)
>80 years	43 (23%)
Gender
Male	87 (48%)
Female	96 (52%)
*Chronic comorbidity*
Yes	181 (99%)
No	02 (01%)

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Table 2

- Characteristics during admission and outcome of the patients (N=183).

Variables	n (%)
*Daily ventilation needs*
None	1 (01)
24 hours	165 (90)
PRN	9 (05)
Others	8 (04)
*Type of ventilation*
Aerosol trach collar	135 (74)
Chronic ventilation	48 (26)
*Reason for admission*
CVA	52 (28)
Multiple comorbidities	33 (18)
Mental disorders	33 (18)
Cancer-related disease	9 (05)
Respiratory disease	10 (06)
Post-operation complication	6 (03)
Infection	21 (12)
Others	19 (10)
*Reason for readmission (respiratory related)*
No admission	55 (30)
Pneumonia-related cases	112 (61)
Non-pneumonia-related cases	16 (09)
*Reason for readmission (respiratory unrelated)*
No admission	60 (33)
Gastrostomy related issues	51 (28)
UTI	33 (18)
AKI	8 (04)
Infection	14 (08)
Others	17 (09)
*Ventilator*
None	3 (02)
Non-invasive	130 (71)
Invasive	50 (27)
HHC program discharge status
Deceased	72 (40)
Alive	109 (60)

PRN: Pro re nata (as needed), CVA: cerebrovascular Accident, UTI: urinary tract infection, AKI: acute kidney Injury, HMV: home mechanical ventilation, ATC: aerosol trach collar, HHC: Home Healthcare

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Table 3

- Frequency of emergency room (ER) and intensive care unit admissions (ICU) (N=183).

Variables	n (%)
*ER visit (Respiratory related and unrelated)*
Yes	27 (15)
No	156 (85)
*Number of ER visits respiratory-related (n=173)*
None	33 (19)
1 – 2	69 (40)
3 – 5	33 (19)
>5	38 (22)
*Number of ER visits respiratory unrelated (n=177)*
None	33 (19)
1 – 2	40 (23)
3 – 5	47 (26)
>5	57 (32)
*ICU visit respiratory-related (n=167)*
Yes	69 (41)
No	98 (59)
*ICU visit respiratory unrelated (n=166)*
Yes	46 (28)
No	120 (72)
*Number of infections respiratory-related*
None	58 (32)
One	42 (23)
2 – 4	53 (29)
5 or more	30 (16)
*Number of infections respiratory unrelated*
None	92 (50)
One	26 (14)
2 – 4	45 (25)
5 or more	20 (11)

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Table 4

- Frequency of organisms during home healthcare admission (N=183).

Parameters	n (%)
*Name of the organism (respiratory unrelated)*
None	74 (40)
Candida Albicans	7 (04)
Escherichia coli	17 (09)
Enterococcus faecalis	8 (04)
Klebsiella pneumoniae	20 (11)
Pseudomonas aeruginosa	14 (08)
Staphylococcus	27 (15)
Acinetobacter	4 (02)
Yeast	5 (03)
Other	7 (04)
*Name of the organism (respiratory related)*
None	68 (37)
Pseudomonas aeruginosa	68 (37)
Klebsiella pneumonia	5 (03)
Staphylococcus aureus	22 (12)
Stenotrophomonas maltophilia	4 (02)
Methicillin-resistant Staphylococcus aureus	3 (02)
Others	13 (07)
*Causes of infection (respiratory related)*
None	58 (32)
Pneumonia	96 (53)
Psuedomonas aeruginosa	18 (09)
Respiratory failure	8 (04)
Other	3 (02)
*Causes of infection (respiratory unrelated)*
None	90 (49)
Infection of gastrostomy	9 (05)
Urinary tract infection	63 (34)
Other infection	12 (07)
Candida auris and other organisms	9 (05)

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Table 5

- Relationship between the outcome after Home Healthcare admission according to the basic demographic and intensive care unit admission characteristics of the patients.

Factor	Deceased (n=72) n (%)	Alive (n=109) n (%)	P-value^{^§}
*Age group*
≤70 years	29 (32)	61 (68)	0.04 ^{^**}
>70 years	43 (47)	48 (53)	0.04 ^{^**}
*Gender*
Male	35 (41)	50 (59)	0.72
Female	37 (39)	59 (61)	0.72
*ICU visit respiratory-related*
Yes	31 (46)	36 (54)	0.14
No	34 (35)	64 (65)	0.14
*ICU visit respiratory unrelated*
Yes	25 (57)	19 (43)	0.003 ^{^**}
No	38 (32)	82 (68)	0.003 ^{^**}
*Reason for admission*
Cerebrovascular accident	24 (48)	26 (252)	0. 24
Multiple comorbidities	8 (24)	25 (76)
Psychological disorders	12 (36)	21 (64)
Infection	8 (38)	13 (63)
Others (cancer-related disease, respiratory disease, post-op complication, et cetera)	20 (45)	24 (55)
*Reason for readmission (respiratory related)*
No admission	19 (35)	36 (65)	0.59
Pneumonia-related disease	47 (43)	63 (57)
Non-pneumonia-related diseases	6 (38)	10 (63)
*Reason for readmission (respiratory unrelated)*
No admission	17 (28)	43 (72)	0.03 ^{^**}
Gastrostomy related issues	18 (35)	33 (65)
Urinary tract infection	16 (52)	15 (48)
Others (acute kidney injury, infection, et cetera)	21 (54)	18 (46)
*Ventilator*
Non-invasive	43 (33)	87 (67)	0.003 ^{^**}
Invasive	28 (57)	21 (43)	0.003 ^{^**}
*Type of ventilation*
Aerosol trach collar	45 (34)	89 (68)	0.004 ^**
Chronic ventilation	27 (57)	20 (43)	0.004 ^**

ICU: intensive care unit

↵§ P-value has been calculated using Chi-square test.
↵** Significant at p<0.05 level.

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Table 6

- Multivariable logistic regression analysis for the prognostic factor of mortality rates after home healthcare admission (N=181).

Factor	AOR	95% CI	P-value
*Age group*
≤70 years	Ref
>70 years	1.995	1.012-3.933	0.046^**
*ICU visit (respiratory unrelated)*
Yes	Ref
No	0.743	0.376-1.470	0.39
*Ventilator*
Non-invasive	Ref
Invasive	2.710	0.226-32.527	0.43
*Type of ventilation*
Aerosol trach collar	Ref
Chronic ventilation	1.186	0.095-14.867	0.90