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Patient Outcomes After Early Versus Late Tracheostomy in the Puerto Rico Trauma Hospital

Romero Vázquez, Ana M. BS; García Rodríguez, Omar DrPH, MS; Ramos Meléndez, Ediel MPH; Rodríguez Ortiz, Pablo MD, FACS, FCCM, FACP, FCCP
doi: 10.1097/PTS.0000000000000268
Original Article: PDF Only

Objective

This study aimed to evaluate the impact of early tracheostomy (ET, ≤7 days) versus that of late tracheostomy (LT, >7 days) on outcomes such as hospital length of stay (LOS), intensive care unit (ICU) days, mechanical ventilation (MV) days, and mortality ratio.

Methods

A historical cohort study was undertaken using charts of patients admitted to the Puerto Rico Trauma Hospital who required MV and underwent tracheostomies, from 2000 to 2013. A logistic regression was performed to evaluate the association between timing of tracheostomy and complications and mortality. To estimate the relationship between ET and outcomes related to hospital stay, a binomial-negative regression was performed. A P < 0.05 was considered statistically significant.

Results

A total of 1134 patients were evaluated, 313 of whom underwent ET and 821 underwent LT. Early tracheostomy patients had a lower Injury Severity Score compared with their counterparts (P = 0.004) and showed lower complications (respiratory failure: odds ratio [OR], 0.61; 95% confidence interval [CI], 0.45–0.84; acute respiratory distress syndrome: OR, 0.44; 95% CI, 0.30–0.64; pneumonia: OR, 0.53; 95% CI, 0.40–0.71; septicemia: OR, 0.48; 95% CI, 0.33–0.70; bacteremia: OR, 0.59; 95% CI, 0.40–0.86) than LT patients. Those with ET had lower MV days (RRadj, 0.74; 95% CI, 0.68–0.82), ICU days (RRadj, 0.66; 95% CI, 0.59–0.73), and LOS (RRadj, 0.74; 95% CI, 0.69–0.80) compared with those with LT, after adjusting for age, Injury Severity Score, and complications. However, there were no differences in mortality ratio (ORadj, 0.66; 95% CI, 0.44–1.01) among ET and LT patients, after adjusting for confounders.

Conclusions

Our results suggested that ET reduced complications, MV days, ICU days, and LOS, having an indirect effect on mortality ratio. Standardized protocols for ET are recommended to enhance health outcomes in trauma patients.

Correspondence: Omar García-Rodríguez, DrPH, MS, Medical Sciences Campus, Medical Center Administration, Puerto Rico, Trauma Hospital, PO Box 2129, San Juan, Puerto Rico 00922–2129 (e-mail: omar.garcia@upr.edu).

The authors disclose no conflict of interest.

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