Analysis of the risk factors for tracheostomy and decannulation after traumatic cervical spinal cord injury in an aging population.

Abstract

Retrospective study. To investigate the risk factors associated with tracheostomy after traumatic cervical spinal cord injury (CSCI) and to identify factors associated with decannulation in an aging population. Advanced critical care and emergency center in Yokohama, Japan. Sixty-five patients over 60 years with traumatic CSCI treated between January 2010 and June 2017 were enrolled. The parameters analyzed were age, sex, American Spinal Injury Association impairment scale score (AIS) at admission and one year after injury, neurological level of injury (NLI), injury mechanism, Charlson's comorbidity index (CCI), smoking history, radiological findings, intubation at arrival, treatment choice, length of intensive care unit (ICU) stay, tracheostomy rate, improvement of AIS, decannulation rate, and mortality after one year. The study included 48 men (74%; mean age 72.8 ± 8.3 years). Twenty-two (34%), 10 (15%), 24 (37%), and 9 (14%) patients were classified as AIS A, B, C, and D, respectively. The tracheostomy group showed significantly more severe degree of paralysis, more patients with major fractures or dislocations, more operative treatment, longer ICU stay, poorer improvement in AIS score after one year and higher rate of intubation at arrival. AIS A at injury was the most significant risk factor for tracheostomy. The non-decannulation group had a significantly higher mortality. The risk factor for failure of decannulation was CCI. Risk factors for tracheostomy after traumatic CSCI were AIS A, operative treatment, major fracture/dislocation, and intubation at arrival. The only factor for failure of decannulation was CCI.