Phillip M. Lee,1 Nikita Nunes Espat,2 Adel Elkbuli3
1 John A. Burns School of Medicine, University of Hawaiʻi, Honolulu, HI
2 NOVA Southeastern College of Osteopathic Medicine Department of Radiology, Fort Lauderdale, FL
3 Orlando Health Regional Center Department of Trauma Surgery, Orlando, FL
The optimal timing of tracheostomy in severe traumatic brain injury (TBI) remains debated.
The objective is to assess clinical outcomes of early (≤7 days) versus late (>7 days) tracheostomy in geriatric patients with isolated severe TBI.
This study utilized the ACS-TQIP-PUF database from 2017-2023 to evaluate clinical outcomes of geria trauma patients with isolated severe TBI treated with early (≤7 days) vs late (>7 days) tracheostomy placement.
There were 1,565 older patients with severe TBI, with 21.7% and 72.5% undergoing early and late tracheostomy, respectively. Early tracheostomy was associated with significantly decreased intensive care unit length of stay (ICU-LOS) (β = -7.263, 95% CI: -8.945 – -5.581, p < 0.001), more ventilator free days (β = 4.020, 95% CI: 2.754 – 5.285, p < 0.001), fewer ventilation days (β = -6.229, 95% CI: -8.053 – -4.405, p < 0.001), and lower risk of ventilator-associated pneumonia (aOR = 0.372, 95% CI: 0.180 – 0.768, p = 0.008). There were no significant associations between tracheostomy timing and in-hospital mortality (aOR = 1.131, 95% CI: 0.642 – 1.994, p = 0.670) or remaining complication rates.
Early tracheostomy within 7 days is a safe management option, with significantly decreased ICU-LOS and ventilation time.
