Early Tracheostomy in Patients with Nontraumatic Intracerebral Hemorrhage is Associated with Lower in-Hospital Complications and Reduced Resource Use Without Increased Mortality.

BACKGROUND

The appropriate timing of tracheostomy in patients with brain injury is debated, with differing opinions on how to improve patient outcomes and limit complications. This study aims to evaluate the association between timing of tracheostomy and resource use (length of stay, hospitalization cost), in-hospital complications (sepsis, acute kidney injury, deep vein thrombosis, pulmonary embolism, ventilator-associated pneumonia, and acute respiratory distress syndrome), and mortality in mechanically ventilated patients with nontraumatic intracerebral hemorrhage (ICH).

METHODS

Using the National Inpatient Sample (2012-2022), we identified adult patients with ICH who underwent mechanical ventilation and tracheostomy. Early tracheostomy (ET) was defined as tracheostomy performed within the first 7 days of admission. Clinical variables included demographics, comorbidities, ICH severity markers, and neurosurgical procedures. Outcomes included hospital complications, length of stay, hospitalization cost, and mortality. Propensity score matching (PSM) was applied to adjust for baseline differences, followed by logistic regression analyses to assess outcomes. Subgroup analyses by medically and surgically managed ICHs and age groups were conducted.

RESULTS

Of 3,342 patients with ICH included in the study, 509 (15.2%) underwent ET. Compared to deferred tracheostomy, ET patients were younger (58 [interquartile range (IQR) 49-69] vs. 60 [IQR 51-70] years, p = 0.027) and had a higher rate of hypertension (76% vs. 69.9%, p = 0.005). After 1:1 PSM, ET was associated with reduced risk of sepsis (odds ratio [OR] 0.665, 95% confidence interval [CI] 0.502-0.881, p = 0.004), lower odds of prolonged hospitalization (OR 0.59, 95% CI 0.423-0.823, p = 0.002), and lower hospitalization cost (OR 0.696, 95% CI 0.504-0.961, p = 0.028). There was no significant association with in-hospital mortality. Subgroup analyses demonstrated consistent associations between ET and lower resource use, except in older adults (≥ 80 years). The reduced risk of sepsis was only observed among medically managed patients with ICH and younger individuals.

CONCLUSIONS

In patients with ICH requiring mechanical ventilation, ET is associated with shorter length of stay and lower hospitalization cost, except among older adults, without any association with in-hospital mortality. These findings support ET as a potentially beneficial strategy for improving resource efficiency in this patient population.