Tracheostomy Timing…It's Personal: Impact of Clinical Practice Variance and Patient-Specific Factors on Outcomes After Tracheostomy in a Community Hospital

Abstract

The inability to accurately predict PMV duration or determine the optimal timing of tracheostomy presents major barriers to progress in critical care. This was a single center, retrospective, observational study that included the years before, during, and after the COVID-19 pandemic. The purpose of our study was to assess the comparative effectiveness of “early” tracheostomy (performed within 10 days of intubation) for PMV based on 1) in-hospital mortality (including hospice transition), 2) patient-specific factors, and 3) discharge-to-home status. All 205 patients admitted to our adult mixed surgical and medical ICU who underwent bedside percutaneous tracheostomy were included from January 2018 to April 2023. During this study period, we observed a significant change in clinical practice over time, with tracheostomy rates increasing steadily from 1.8% to 5.6%. Based on the similarities of the APACHE II and SOFA scores, there were no discernable differences in the severity of illness. Early compared to late tracheostomy was associated with significantly fewer days on mechanical ventilation (p < 0.01) and ICU length of stay (p < 0.04). Time in the hospital was not different but a significantly higher percentage of patients with early tracheostomy were discharged home (p < 0.01). In a community hospital setting, the significant benefit of early tracheostomy was conditional upon certain patient characteristics. We recommend a personalized approach to tracheostomy timing based upon these patient factors.