Social, functional and quality-of-life outcomes among long term acute care hospital survivors with tracheostomy

RationalePatients receiving prolonged mechanical ventilation are often discharged to long-term acute care hospitals (LTACHs) with hopes of recovery and ultimately return to the community. Among those who survive and undergo tracheostomy, little is known about their quality of life and social outcomes after LTACH discharge. ObjectiveMeasure health related quality of life in a cohort of critical illness survivors who underwent tracheostomy and an LTACH stay MethodsSingle center, prospective observational cohort study conducted at a long-term acute care hospital between 2022-2024. Adults with prolonged mechanical ventilation requiring tracheostomy were eligible. Survivors or surrogates completed a telephone survey 3-6 months after LTACH admission. Surveys included the Katz Index of Independence in Activities of Daily Living (ADL) and Patient-Reported Outcome Measurement Information System (PROMIS) measures of physical, mental, and social health. Descriptive statistics summarized scores; exploratory analyses examined associations between persistent tracheostomy and residence. ResultsSeventy participants were enrolled (median age 64 years; 58.6% male). Median ICU length of stay was 40 days prior to LTACH transfer. By LTACH discharge, 39 people (56%) had been decannulated. At a median follow-up of 5.5 months, 50 participants (71%) were alive, 39 completed the survey. Most respondents reported impairments in feeding, dressing, and bathing. PROMIS t-scores demonstrated severe impairments in physical function (median 26.7), and ability to participate in social roles (37.0), with high symptom burden of depression (61.9) and anxiety (58.3). Greater impairment was observed among participants with ongoing tracheostomy or were not residing at home. Home residence did not differ significantly by decannulation status (61.8% decannulated vs. 46.7% not decannulated; OR 1.85 (95% CI 0.54, 6.30)). ConclusionsSurvivors of PMV and LTACH admission experience marked functional impairments, restricted participation in social roles, and prominent symptoms of depression and anxiety--particularly among patients not living at home or with persistent tracheostomy. These data may help clinicians prepare patients and families for life after tracheostomy and guide tailored support addressing multifaceted needs. Primary Funding SourceNational Institutes of Health