American journal of surgery · 2024
Timing of tracheostomy in geriatric patients with isolated severe traumatic brain injury: A nationwide analysis.
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Morales Rosario Omar I, Lagazzi Emanuele, Panossian Vahe S, Plascevic Josip, Arda Yasmin, Abiad May, Nzenwa Ikemsinachi, Velmahos George C, Hwabejire John O
Аннотация
BACKGROUND: The impact of tracheostomy timing on outcomes is unclear in geriatric patients with traumatic brain injury (TBI).
METHODS: Patients aged≥65 with isolated severe TBI who underwent tracheostomy were identified in the ACS-TQIP 2017-2020 database. Patients were grouped by early (<10 days) vs. late (≥10 days) tracheostomy. Propensity score matching accounted for confounders. Outcomes included mortality, hospital (H-LOS) and ICU length of stay (ICU-LOS), ventilator days, and complications.
RESULTS: Among 1385 patients, 637 (46.0 %) had an early tracheostomy. Following propensity score matching, early tracheostomy was associated with shorter H-LOS (18 vs. 25 days, p < 0.001), ICU-LOS (14 vs. 20 days, p < 0.001), and fewer ventilator days (12 vs. 17 days, p < 0.001). Furthermore, the incidence of deep vein thrombosis was lower in the early tracheostomy group (6.7 % vs. 11.3 %, p = 0.024), but mortality rates were similar (11.1 % vs. 9.5 %, p = 0.48).
CONCLUSION: Early tracheostomy in geriatric patients with isolated severe TBI is associated with reduced LOS, ventilator days, and complications, suggesting potential benefits of earlier intervention.
METHODS: Patients aged≥65 with isolated severe TBI who underwent tracheostomy were identified in the ACS-TQIP 2017-2020 database. Patients were grouped by early (<10 days) vs. late (≥10 days) tracheostomy. Propensity score matching accounted for confounders. Outcomes included mortality, hospital (H-LOS) and ICU length of stay (ICU-LOS), ventilator days, and complications.
RESULTS: Among 1385 patients, 637 (46.0 %) had an early tracheostomy. Following propensity score matching, early tracheostomy was associated with shorter H-LOS (18 vs. 25 days, p < 0.001), ICU-LOS (14 vs. 20 days, p < 0.001), and fewer ventilator days (12 vs. 17 days, p < 0.001). Furthermore, the incidence of deep vein thrombosis was lower in the early tracheostomy group (6.7 % vs. 11.3 %, p = 0.024), but mortality rates were similar (11.1 % vs. 9.5 %, p = 0.48).
CONCLUSION: Early tracheostomy in geriatric patients with isolated severe TBI is associated with reduced LOS, ventilator days, and complications, suggesting potential benefits of earlier intervention.