Abstract W MP98: Tracheostomy Timing Impacts Stroke Recovery

Abstract

The timing of tracheostomy in stroke patients unable to protect their airway has become a topic of debate. Proponents for early tracheostomy cite benefits including less ventilation-associated pneumonia, less sedative drug use, shorter length of stay, and reduced mortality in comparison to late tracheostomy. We examined the timing of tracheostomy on stroke patient outcomes across the United States using the Nationwide Inpatient Sample (2008-2010). Our hypothesis was that patients receiving an early tracheostomy would fare better at discharge in comparison to their counterpart receiving a late tracheostomy. Independent samples t-tests and chi-squared tests were used to make comparisons between early (≤10 days) and late (11-25 days) tracheostomy. Multivariable models, adjusted for confounding factors, investigated outcome measures. There were 13,165 stroke cases included in the study (5,591 in the early tracheostomy group and 7,574 in the late tracheostomy group). Univariate comparisons between groups can be found in the included table. Patients receiving an early tracheostomy had a significant reduction in the odds of ventilator-associated pneumonia in comparison to the late tracheostomy group (OR: 0.688, 95% CI: 0.495 - 0.956, P=.026). The adjusted length of stay for patients receiving an early tracheostomy was significantly lower in comparison to the late tracheostomy group (P<.001) and was associated with a 17% reduction in total hospital costs (P<.001). In conclusion, early tracheostomy for stroke patients may reduce the incidence of ventilator-associated pneumonia, thereby shortening the hospital stay and lowering total hospital costs. These relationships warrant further investigation in a large prospective multicenter trial.