Early Versus Late Tracheostomy in Patients with Traumatic Brain Injury: A US Nationwide Analysis

Background: One of the most critical issues in patients suffering from traumatic brain injury (TBI) is protecting the airway and attempting to keep a secure airway. It is evident that tracheostomy in patients with TBI after 7-14 days can have favorable outcomes if the patient cannot be extubated; however, some clinicians have recommended early tracheostomy before 7 days. Methods: A retrospective cohort of inpatient study participants was queried from the National Inpatient Sample to include patients with TBI between 2016 and 2020 undergoing tracheostomy and outcomes between the two groups of early tracheostomy (ET) (< 7 days from admission) and late tracheostomy (LT) (>= 7 days from admission) were compared. Results: We reviewed 219,005 patients with TBI, out of whom 3.04% had a tracheostomy. Patients in the ET group were younger than those in the LT group (45.02 +/- 19.38 years old vs. 48.68 +/- 20.50 years old, respectively, p < 0.001), mainly men (76.64% vs. 73.73%, respectively, p = 0.01), and mainly White race (59.88% vs. 57.53%, respectively, p = 0.33). The patients in the ET group had a significantly shorter length of stay as compared with those in the LT group (27.78 +/- 25.96 days vs. 36.32 +/- 29.30 days, respectively, p < 0.001) and had a significantly lower hospital charge ($502,502.436 +/- 427,060.81 vs. $642,739.302 +/- 516,078.94 per patient, respectively, p < 0.001). The whole TBI cohort mortality was reported at 7.04%, which was higher within the ET group compared with the LT group (8.69% vs. 6.07%, respectively, p < 0.001). Patients in the LT had higher odds of developing any infection (odds ratio [OR] 1.43 [1.22-1.68], p < 0.001), emerging sepsis (OR 1.61 [1.39-1.87], p < 0.001), pneumonia (OR 1.52 [1.36-1.69], p < 0.001), and respiratory failure (OR 1.30 [1.09-1.55], p = 0.004). Conclusions: This study shows that ET can provide notable and significant benefits for patients with TBI. Future highquality prospective studies should be performed to investigate and shed more light on the ideal timing of tracheostomy in patients with TBI.

Automated summary

Early tracheostomy (ET) in patients with traumatic brain injury (TBI) can provide significant benefits, including a shorter length of stay and lower hospital charges. However, it is also associated with increased mortality and complications such as infections. Further high-quality prospective studies are needed to determine the optimal timing of tracheostomy in TBI patients.