Introduction
Optimal timing and necessity of tracheostomy in neurocritical care vary widely due to limited data on benefits and risks in stroke patients, and conflicting meta-analyses.1,2 To understand implications of tracheostomy in this population, we compared timing and clinical outcomes of tracheostomy in patients with stroke to those who underwent tracheostomy for other indications.
Methods
This retrospective cohort study at a single tertiary care center (9/2006-8/2013) included neurocritical care patients who underwent percutaneous tracheostomy. Data include demographics (age, sex, race, BMI) and clinical data (tracheostomy indication, SOFA score, Glasgow Coma Scale score, Charlson Comorbidity Index, and hospital-acquired complications). Primary outcomes were NCCU and hospital lengths of stay, ventilator days, hospital costs, discharge location, and reintubation rates. Outcomes were compared between stroke and non-stroke patients, as well as early (<14 days) and late (≥14 days) tracheostomies overall and within the stroke subgroup.
Results
Among 290 patients, 145 suffered a stroke. Among stroke patients, there were no demographic differences between early and late tracheostomy groups. Stroke patients had shorter NCCU stays (p=0.03), fewer ventilator days (p=0.02), lower hospital costs (p=0.01), lower reintubation rates (p=0.02), and different discharge locations (p=0.02) compared to non-stroke patients. Early tracheostomy patients had shorter NCCU (p<0.01) and hospital stays (p<0.01) and lower costs (p<0.01) than late. They were also less likely to be reintubated (p=0.01). In stroke patients, early tracheostomy was associated with shorter NCCU (p<0.001) and hospital stays (p=0.002), and lower costs (p<0.001), but with a higher complication rate (p=0.02) and lower reintubation likelihood (p=0.01) compared to late tracheostomy.
Conclusion
This study highlights the impact of tracheostomy timing on outcomes in neurocritical care, especially for stroke patients. Early tracheostomy is linked to better outcomes such as shorter NCCU stays and reduced costs, though it carries a higher complication rate in stroke patients. Tracheostomy timing must be carefully evaluated to optimize outcomes while managing risks, with a tailored approach for each patient.
References
Qiu, Y., Yin, Z., Wang, Z., Xie, M., Chen, Z., Wu, J., & Wang, Z. (2023). Early versus late tracheostomy in stroke-related patients: A systematic review and meta-analysis. Journal of Clinical Neuroscience, 114, 48-54. doi:https://doi.org/10.1016/j.jocn.2023.06.004.
Andriolo, B. N., Andriolo, R. B., Saconato, H., Atallah, Á. N., & Valente, O. (2015). Early versus late tracheostomy for critically ill patients. Cochrane Database of Systematic Reviews(1). doi:https://doi.org/10.1002/14651858.CD007271.pub3