Introduction: Few studies have specifically evaluated the timing of tracheostomy in the subarachnoid hemorrhage population, where cerebral edema, delayed cerebral ischemia, and the tempo of neurologic recovery provide unique considerations. The goal of this study was to utilize a national population to investigate the association of tracheostomy timing with complications.
Methods: Poor grade patients requiring mechanical ventilation with aneurysmal subarachnoid hemorrhage were extracted from the Nationwide Inpatient Sample (NIS, 2002-2011). Multivariable linear regression analyzed predictors for tracheostomy timing and multivariable logistic regression evaluated the association of timing of intervention with mortality, complications, and discharge to institutional care. Covariates included patient demographics (including age, sex, race/ethnicity, insurance status, and socioeconomic status), comorbidities, severity of subarachnoid hemorrhage (measured with the NIS-SAH severity scale), and hospital characteristics.
Results: In this analysis, 1,428 admissions were included and the median time to tracheostomy was 13 (interquartile range: 9-17) days. Higher socioeconomic status and delayed aneurysm repair were associated with later tracheostomy placement. Neither mortality nor discharge to institutional care were associated with the timing of tracheostomy. Furthermore, the odds of neurologic, pulmonary, and cardiac complications, stroke, and decubitus ulcers did not differ significantly by tracheostomy time. However, when the timing of intervention was evaluated continuously, later tracheostomy was associated with greater odds of gastrointestinal (odds ratio (OR): 1.031, 95% confidence interval (CI): 1.014-1.048, p<0.001), venous thromboembolic (OR: 1.022, 95% CI: 1.000-1.044, p=0.047), and infectious complications (OR: 1.037, 95% CI; 1.007-1.065, p=0.001). The odds of gastrointestinal complications increased when tracheostomy was performed 14 days after admission, while the odds of infectious and venous thromboembolic complications increased after 7 days.
Conclusions: In this national analysis, the timing of tracheostomy was not associated with mortality, neurologic complications, or discharge disposition. However, late tracheostomy was associated with increased odds of some medical complications.
Patient Care: This analysis highlights the association of timing of tracheotomy with outcomes, suggesting that early tracheostomy is associated with decreased odds of some medical complications (gastrointestinal, venous thromboembolic, and infectious) in the subarachnoid hemorrhage population.
Learning Objectives: By the conclusion of this session, participants should be able to 1) describe the unique factors when considering tracheostomy timing in the subarachnoid hemorrhage population; 2) identify predictors of tracheostomy in this dataset; and 3) describe the association of tracheotomy timing with outcomes after subarachnoid hemorrhage.