TY - JOUR
T1 - Early Versus Late Tracheostomy in Patients with Traumatic Brain Injury
T2 - A US Nationwide Analysis
AU - Azari Jafari, Amirhossein
AU - Mirmoeeni, Seyyedmohammadsadeq
AU - Momtaz, David
AU - Kotzur, Travis
AU - Murtha, Gregory
AU - Garcia, Carlos
AU - Moran, Maggie
AU - Martinez, Paola
AU - Chen, Kevin
AU - Krishnakumar, Hari
AU - Seifi, Ali
N1 - Publisher Copyright:
© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2023.
PY - 2024/4
Y1 - 2024/4
N2 - Background: One of the most critical issues in patients suffering from traumatic brain injury (TBI) is protecting the airway and attempting to keep a secure airway. It is evident that tracheostomy in patients with TBI after 7–14 days can have favorable outcomes if the patient cannot be extubated; however, some clinicians have recommended early tracheostomy before 7 days. Methods: A retrospective cohort of inpatient study participants was queried from the National Inpatient Sample to include patients with TBI between 2016 and 2020 undergoing tracheostomy and outcomes between the two groups of early tracheostomy (ET) (< 7 days from admission) and late tracheostomy (LT) (≥ 7 days from admission) were compared. Results: We reviewed 219,005 patients with TBI, out of whom 3.04% had a tracheostomy. Patients in the ET group were younger than those in the LT group (45.02 ± 19.38 years old vs. 48.68 ± 20.50 years old, respectively, p < 0.001), mainly men (76.64% vs. 73.73%, respectively, p = 0.01), and mainly White race (59.88% vs. 57.53%, respectively, p = 0.33). The patients in the ET group had a significantly shorter length of stay as compared with those in the LT group (27.78 ± 25.96 days vs. 36.32 ± 29.30 days, respectively, p < 0.001) and had a significantly lower hospital charge ($502,502.436 ± 427,060.81 vs. $642,739.302 ± 516,078.94 per patient, respectively, p < 0.001). The whole TBI cohort mortality was reported at 7.04%, which was higher within the ET group compared with the LT group (8.69% vs. 6.07%, respectively, p < 0.001). Patients in the LT had higher odds of developing any infection (odds ratio [OR] 1.43 [1.22–1.68], p < 0.001), emerging sepsis (OR 1.61 [1.39–1.87], p < 0.001), pneumonia (OR 1.52 [1.36–1.69], p < 0.001), and respiratory failure (OR 1.30 [1.09–1.55], p = 0.004). Conclusions: This study shows that ET can provide notable and significant benefits for patients with TBI. Future high-quality prospective studies should be performed to investigate and shed more light on the ideal timing of tracheostomy in patients with TBI.
AB - Background: One of the most critical issues in patients suffering from traumatic brain injury (TBI) is protecting the airway and attempting to keep a secure airway. It is evident that tracheostomy in patients with TBI after 7–14 days can have favorable outcomes if the patient cannot be extubated; however, some clinicians have recommended early tracheostomy before 7 days. Methods: A retrospective cohort of inpatient study participants was queried from the National Inpatient Sample to include patients with TBI between 2016 and 2020 undergoing tracheostomy and outcomes between the two groups of early tracheostomy (ET) (< 7 days from admission) and late tracheostomy (LT) (≥ 7 days from admission) were compared. Results: We reviewed 219,005 patients with TBI, out of whom 3.04% had a tracheostomy. Patients in the ET group were younger than those in the LT group (45.02 ± 19.38 years old vs. 48.68 ± 20.50 years old, respectively, p < 0.001), mainly men (76.64% vs. 73.73%, respectively, p = 0.01), and mainly White race (59.88% vs. 57.53%, respectively, p = 0.33). The patients in the ET group had a significantly shorter length of stay as compared with those in the LT group (27.78 ± 25.96 days vs. 36.32 ± 29.30 days, respectively, p < 0.001) and had a significantly lower hospital charge ($502,502.436 ± 427,060.81 vs. $642,739.302 ± 516,078.94 per patient, respectively, p < 0.001). The whole TBI cohort mortality was reported at 7.04%, which was higher within the ET group compared with the LT group (8.69% vs. 6.07%, respectively, p < 0.001). Patients in the LT had higher odds of developing any infection (odds ratio [OR] 1.43 [1.22–1.68], p < 0.001), emerging sepsis (OR 1.61 [1.39–1.87], p < 0.001), pneumonia (OR 1.52 [1.36–1.69], p < 0.001), and respiratory failure (OR 1.30 [1.09–1.55], p = 0.004). Conclusions: This study shows that ET can provide notable and significant benefits for patients with TBI. Future high-quality prospective studies should be performed to investigate and shed more light on the ideal timing of tracheostomy in patients with TBI.
KW - Early tracheostomy
KW - Late tracheostomy
KW - TBI
KW - Tracheostomy
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85164151765&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85164151765&partnerID=8YFLogxK
U2 - 10.1007/s12028-023-01778-2
DO - 10.1007/s12028-023-01778-2
M3 - Article
C2 - 37415023
AN - SCOPUS:85164151765
SN - 1541-6933
VL - 40
SP - 551
EP - 561
JO - Neurocritical Care
JF - Neurocritical Care
IS - 2
ER -