Surgery Open Science · Published 2025-10-10 · DOI 10.1016/j.sopen.2025.10.001
Introduction: The optimal timing for tracheostomy among patients with traumatic brain injury (TBI) remains controversial. Earlier tracheostomy is hypothesized to reduce sedation requirements and allow for earlier mobility. We examined the association of tracheostomy timing with clinical endpoints among a national cohort of TBI patients. Methods: All adult patients (≥18 years) with TBI, defined as head abbreviated injury scale ≥3, undergoing tracheostomy were identified in the 2018 to 2021 Trauma Quality Improvement Program (TQIP) database. Patients were stratified into groups labeled Early (≤10 days) and Delayed (>10 days) using the median day of tracheostomy initiation of the study cohort. Multivariable regression models were developed to assess the association between tracheostomy timing and outcomes including in-hospital mortality, pneumonia, and total ventilator days. Results: Of 24,517 patients, 51.1 % underwent tracheostomy within 10 days of admission (Early). Compared to Delayed, Early were more commonly younger (42 [28–59] vs 48 years [31–63]; p < 0.001) and privately insured (42.9 vs 41.1 %, p < 0.001). Following multivariable adjustment, factors associated with increased likelihood of early tracheostomy included penetrating trauma (AOR 1.53, 95 % CI 1.37–1.72; ref.: Blunt) and severe facial injury (AOR 1.55, 95 % CI 1.39–1.72.) While early tracheostomy did not alter mortality (AOR 1.10, 95 % CI 0.99–1.24), patients had reduced pneumonia (AOR 0.66, 95 % CI 0.62–0.21) and reduced ventilator days (β −7.05 days, 95 % CI -7.35- -6.75). Conclusion: Early tracheostomy is associated with reduced complications without altering mortality. These findings suggest the safety and potential benefits of early tracheostomy. Further prospective studies are warranted to explore the underlying mechanisms. Two sentence summary: Although the optimal timing for tracheostomy among patients with traumatic brain injury remains controversial, previous literature has shown timely tracheostomy to reduce sedation requirements and allow for earlier mobility. Our findings found early tracheostomy to be linked with reduced time on the ventilator, length of stay, and risk of complications.
Abstract from DOAJ. Public domain (CC0 1.0).
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