Emergency spinal stabilization in polytrauma: A clinical marker for tracheostomy rather than an independent risk factor for prolonged ventilation.

BACKGROUND

Emergency Spinal Stabilization (ESS) represents a cornerstone of contemporary polytrauma management, yet its independent impact on respiratory outcomes remains a subject of ongoing debate. This study investigates whether tracheostomy (TS) rates and duration of mechanical ventilation (DMV) are primarily driven by the surgical intervention itself, neurological impairment, or overall injury severity.

METHODS

We retrospectively analyzed 914 severely injured patients (ISS≥16) admitted to a Level I trauma center. Primary outcomes were TS rate and DMV. Multivariate logistic and linear regression models were employed to isolate the independent effects of ESS, injury severity (ISS, AIS), and neurological status. A dedicated subgroup analysis of operated patients (n = 85) evaluated surgical technique (e.g., ventral stabilization) and physiological severity scores (SAPS2, TISS-10).

RESULTS

ESS patients demonstrated a significantly elevated TS rate (39.5% vs. 20.6%, p < 0.001) despite being younger and exhibiting lower physiological severity at admission (SAPS2 28.0 vs. 33.5, p = 0.013). In the total cohort, thoracic injury (OR 1.99, p < 0.001) and ISS (OR 1.04, p = 0.002) independently predicted TS; ESS was not an independent predictor (p = 0.27). Within the ESS subgroup, spinal cord injury (SCI) emerged as the strongest predictor for TS (OR 3.33, p = 0.032), whereas surgical invasiveness (ventral stabilization) exerted no independent impact (p = 0.520). DMV was exclusively determined by ISS (p < 0.001); neither neurological status nor surgical technique independently influenced ventilation duration.

CONCLUSIONS

ESS serves as a reliable clinical marker for increased TS requirements but does not independently prolong mechanical ventilation. TS necessity is primarily dictated by SCI and overall injury burden rather than surgical invasiveness. Early TS in ESS patients with SCI appears to effectively compensate for physiological deficits, aligning ventilation durations with those of non-neurologically impaired patients. ESS should therefore be recognized as a clinical "red flag" prompting proactive multidisciplinary airway management to optimize respiratory weaning strategies.