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. 2023 Apr;173(4):927-935.
doi: 10.1016/j.surg.2022.11.017. Epub 2022 Nov 23.

Optimal timing and outcomes among COVID-19 patients undergoing tracheostomy

Steven K M Vuu  1 , Tandis Soltani  2 , Huazhi Liu  3 , Jennifer DeMuro  2 , Laura Mena Albors  2 , Ettore Crimi  2 , Darwin N Ang  4
Affiliations

Optimal timing and outcomes among COVID-19 patients undergoing tracheostomy

Steven K M Vuu et al. Surgery. 2023 Apr.

Abstract

Background: Patients who require mechanical ventilation secondary to severe COVID-19 infection have poor survival. It is unknown if the benefit of tracheostomy extends to COVID-19 patients. If so, what is the optimal timing?

Methods: Retrospective cohort study within a large hospital system in the United States. The population included patients with COVID-19 from January 1, 2020 to September 30, 2020. In total, 93,918 cases were identified. They were excluded if no intubation or tracheostomy, underwent tracheostomy before intubation, <18 years old, hospice patients before admission, and bacterial pneumonia. In total, 5,911 patients met the criteria. Outcomes between patients who underwent endotracheal intubation only versus tracheostomy were compared. The primary outcome was inpatient mortality. All patients who underwent tracheostomy versus intubation only were compared. Three cohort analysis compared early (<10 days) versus late (>10 days) tracheostomy versus control. Eight cohort analysis compared days 0-2, days 3-6, days 7-10, days 11-14, days 15-18, days 19-22, and days 23+ to tracheostomy versus control.

Results: There was an overall inpatient mortality rate of 37.5% in the tracheostomy cohort compared to 54.4% in the control group (P < .0001). There was an early tracheostomy group inpatient mortality rate of 44.7% (adjusted odds ratio 0.73, 95% confidence interval 0.52-1.01) compared to 33.1% (adjusted odds ratio 0.44, 95% confidence interval 0.34-0.58) in the late tracheostomy group.

Conclusion: COVID-19 patients with tracheostomy had a significantly lower mortality rate compared to intubated only. Optimal timing for tracheostomy placement for COVID-19 patients is 11 days or later. Future studies should focus on early tracheostomy patients.

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Figures

Figure 1
Figure 1
Patient population.
Figure 2
Figure 2
Inpatient mortality (adjusted odds ratio) with 95% confidence intervals as a function of days to tracheostomy. The 95% confidence intervals that do not cross 1 are statistically significant.
Figure 3
Figure 3
Total mechanical ventilator days and additional mechanical ventilator days after tracheostomy. The black line represents the mean total mechanical ventilation days. The blue line represents the additional mechanical ventilation days after tracheostomy.
See this image and copyright information in PMC

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