Outcomes of Early Versus Late Tracheostomy in Geriatric Trauma With Severe Traumatic Brain Injury.

BACKGROUND

Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in older adults, often necessitating tracheostomy for prolonged ventilation. The optimal timing of tracheostomy in severe TBI remains debated.

OBJECTIVE

To compare clinical outcomes of early (≤7 days) versus late (>7 days) tracheostomy in older patients with isolated severe TBI.

METHODS

This retrospective cohort study utilized the American College of Surgeons Trauma Quality Improvement Participant Use File database from 2017 to 2023 to evaluate clinical outcomes of older trauma patients with isolated severe TBI treated with early (≤7 days) versus late (>7 days) tracheostomy placement.

RESULTS

Of 1,565 older patients with severe TBI, 21.7% received an early tracheostomy and 72.5% a late tracheostomy. Early tracheostomy was associated with significantly shorter intensive care unit length of stay (ICU-LOS) (β= -7.26, 95% CI [-8.95, -5.58], p < .001), more ventilator-free days (β= 4.02, 95% CI [2.75, 5.29], p < .001), fewer ventilator days (β= -6.23, 95% CI [-8.05, -4.41, p < .001), and lower risk of ventilator-associated pneumonia (adjusted odds ratio, aOR = 0.37, 95% CI [0.18, 0.77], p = .008). No significant associations existed between tracheostomy timing and inhospital mortality (aOR = 1.13, 95% CI [0.64, 1.99], p = .670) or remaining complication rates.

CONCLUSION

Early tracheostomy within 7 days for older patients with severe TBI is a safe management option, with significantly decreased ICU-LOS and ventilation time, improved or comparable complication rates, and no significant increase in mortality rates compared to late tracheostomy.