Early Tracheostomy in Older Trauma Patient Is Associated With Comparable Outcomes to Younger Cohort

Authors

James A. Zebley, Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
Karen Wanersdorfer, Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
Parker Chang, Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
Rachel Schwartz, Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
Maximilian Peter Forssten, School of Medical Sciences, Orebro University, Orebro, Sweden; Division of Trauma & Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden.
Yang Cao, Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden.
Shahin Mohseni, School of Medical Sciences, Orebro University, Orebro, Sweden; Division of Trauma & Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden.
Babak Sarani, Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
Susan Kartiko, Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia. Electronic address: skartiko@mfa.gwu.edu.

Document Type

Journal Article

Publication Date

10-1-2023

Journal

The Journal of surgical research

Volume

290

DOI

10.1016/j.jss.2023.03.051

Keywords

Geriatrics; ICU; Outcomes; Tracheostomy

Abstract

INTRODUCTION: Early tracheostomy (ET) is associated with a lower incidence of pneumonia (PNA) and mechanical ventilation duration (MVD) in hospitalized patients with trauma. The purpose of this study is to determine if ET also benefits older adults compared to the younger cohort. METHODS: Adult hospitalized trauma patients who received a tracheostomy as registered in The American College of Surgeons Trauma Quality Improvement Program from 2013 to 2019 were analyzed. Patients with tracheostomy prior to admission were excluded. Patients were stratified into 2 cohorts consisting of those aged ≥65 and those aged <65. These cohorts were analyzed separately to compare the outcomes of ET (<5 d; ET) versus late tracheostomy (LT) (≥5 d; LT). The primary outcome was MVD. Secondary outcomes were in-hospital mortality, hospital length of stay (HLOS), and PNA. Univariate and multivariate analyses were performed with significance defined as P value < 0.05. RESULTS: In patients aged <65, ET was performed within a median of 2.3 d (interquartile range, 0.47-3.8) after intubation and a median of 9.9 d (interquartile range, 7.5-13) in the LT group. The ET group's Injury Severity Score was significantly lower with fewer comorbidities. There were no differences in injury severity or comorbidities when comparing the groups. ET was associated with lower MVD (d), PNA, and HLOS on univariate and multivariate analyses in both age cohorts, although the degree of benefit was higher in the less than 65 y cohort [ET versus LT MVD: 5.08 (4.78-5.37), P < 0.001; PNA: 1.45 (1.36-1.54), P < 0.001; HLOS: 5.48 (4.93-6.04), P < 0.001]. Mortality did not differ based on time to tracheostomy. CONCLUSIONS: ET is associated with lower MVD, PNA, and HLOS in hospitalized patients with trauma regardless of age. Age should not factor into timing for tracheostomy placement.

APA Citation

Zebley, James A.; Wanersdorfer, Karen; Chang, Parker; Schwartz, Rachel; Forssten, Maximilian Peter; Cao, Yang; Mohseni, Shahin; Sarani, Babak; and Kartiko, Susan, "Early Tracheostomy in Older Trauma Patient Is Associated With Comparable Outcomes to Younger Cohort" (2023). GW Authored Works. Paper 2665.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2665

Department

Surgery