17.05 Timing of Tracheostomy and its Association with Length of Stay and Mortality

Posted on January 18, 2016

Z. Wells2, M. Bascom2, Z. Gauthier2, M. Suh2, B. Meloro2, A. Lopez2, M. Goodwin4, A. H. Parsikia1, J. A. Ortiz4, P. S. Leung1, A. R. Joshi1,3 1Einstein Healthcare Network,Surgery,Philadelphia, PA, USA 2Philadelphia College Of Osteopathic Medicine,Philadelphia, PA, USA 3Jefferson Medical College,Surgery,Philadelphia, PA, USA 4University Of Toledo,Surgery,Toledo, OH, USA

Introduction:
Patients requiring long-term mechanical ventilation may benefit from early tracheostomy. However, the most appropriate timing of tracheostomy is still not well-determined.

Methods:
We reviewed 500 consecutive tracheostomies over four years. After exclusion criteria were applied, 417 patients remained. We divided the cohort according to two benchmarks: tracheostomy before and after 7 days, and before and after 10 days on mechanical ventilation. We then analyzed ICU length of stay (LOS), overall LOS, mortality, laboratory data, demographics, type of tracheostomy, post-operative complications, type of ICU, type of surgeon, and disposition after discharge. We compared the variables with uni- and multi-variate logistic regression tests to determine if any were prognostic.

Results:
The early and late cohorts were comparable with regard to pre-operative characteristics and post-operative complications. Pre-operative albumin was significantly higher in the early group. Earlier tracheostomy was associated with shorter ICU and overall LOS. Survival rates at 1, 6, and 12 months were not statistically different. In multivariate logistic regression, higher albumin predicted decreased in-hospital mortality (p=0.003) and higher INR predicted increased in-hospital mortality (p=0.002)—better than timing of tracheostomy.

Conclusion:
Early tracheostomy was associated with decreased ICU LOS (by 9-10 days) and overall LOS (by 8-10 days). Timing of tracheostomy was not associated with a difference in mortality or disposition after discharge. Preoperative albumin and INR are predictive for in-hospital mortality among patients who undergo tracheostomy. Early tracheostomy does appear to be highly significantly associated with decreased LOS in the ICU and hospital, and therefore should be encouraged.