TY - JOUR
T1 - Tracheostomy After Severe Acute Brain Injury
T2 - Trends and Variability in the USA
AU - Krishnamoorthy, Vijay
AU - Hough, Catherine L.
AU - Vavilala, Monica S.
AU - Komisarow, Jordan
AU - Chaikittisilpa, Nophanan
AU - Lele, Abhijit V.
AU - Raghunathan, Karthik
AU - Creutzfeldt, Claire J.
N1 - Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.
PY - 2019/6/15
Y1 - 2019/6/15
N2 - Background/Objective: Severe acute brain injury (SABI) is responsible for 12 million deaths annually, prolonged disability in survivors, and substantial resource utilization. Little guidance exists regarding indication or optimal timing of tracheostomy after SABI. Our aims were to determine national trends in tracheostomy utilization among mechanically ventilated patients with SABI in the USA, as well as to examine factors associated with tracheostomy utilization following SABI. Methods: We conducted a population-based retrospective cohort study using the National Inpatient Sample from 2002 to 2011. We identified adult patients with SABI, defined as a primary diagnosis of stroke, traumatic brain injury or post-cardiac arrest who received mechanical ventilation for greater than 96 h. We analyzed trends in tracheostomy utilization over time and used multilevel mixed-effects logistic regression to analyze factors associated with tracheostomy utilization. Results: There were 94,082 hospitalizations for SABI during the study period, with 30,455 (32%) resulting in tracheostomy utilization. The proportion of patients with SABI who received a tracheostomy increased during the study period, from 28.0% in 2002 to 32.1% in 2011 (p < 0.001). Variation in tracheostomy utilization was noted based on patient and facility characteristics, including higher odds of tracheostomy in large hospitals (OR 1.34, 95% CI 1.18–1.53, p < 0.001, compared to small hospitals), teaching hospitals (OR 1.15, 95% CI 1.06–1.25, p = 0.001, compared to non-teaching hospitals), and urban hospitals (OR 1.60, 95% CI 1.33–1.92, p < 0.001, compared to rural hospitals). Conclusions: Tracheostomy utilization has increased in the USA among patients with SABI, with wide variation by patient and facility-level factors.
AB - Background/Objective: Severe acute brain injury (SABI) is responsible for 12 million deaths annually, prolonged disability in survivors, and substantial resource utilization. Little guidance exists regarding indication or optimal timing of tracheostomy after SABI. Our aims were to determine national trends in tracheostomy utilization among mechanically ventilated patients with SABI in the USA, as well as to examine factors associated with tracheostomy utilization following SABI. Methods: We conducted a population-based retrospective cohort study using the National Inpatient Sample from 2002 to 2011. We identified adult patients with SABI, defined as a primary diagnosis of stroke, traumatic brain injury or post-cardiac arrest who received mechanical ventilation for greater than 96 h. We analyzed trends in tracheostomy utilization over time and used multilevel mixed-effects logistic regression to analyze factors associated with tracheostomy utilization. Results: There were 94,082 hospitalizations for SABI during the study period, with 30,455 (32%) resulting in tracheostomy utilization. The proportion of patients with SABI who received a tracheostomy increased during the study period, from 28.0% in 2002 to 32.1% in 2011 (p < 0.001). Variation in tracheostomy utilization was noted based on patient and facility characteristics, including higher odds of tracheostomy in large hospitals (OR 1.34, 95% CI 1.18–1.53, p < 0.001, compared to small hospitals), teaching hospitals (OR 1.15, 95% CI 1.06–1.25, p = 0.001, compared to non-teaching hospitals), and urban hospitals (OR 1.60, 95% CI 1.33–1.92, p < 0.001, compared to rural hospitals). Conclusions: Tracheostomy utilization has increased in the USA among patients with SABI, with wide variation by patient and facility-level factors.
KW - Brain injury
KW - Respiratory failure
KW - Tracheostomy
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U2 - 10.1007/s12028-019-00697-5
DO - 10.1007/s12028-019-00697-5
M3 - Article
C2 - 30919303
AN - SCOPUS:85063220716
SN - 1541-6933
VL - 30
SP - 546
EP - 554
JO - Neurocritical Care
JF - Neurocritical Care
IS - 3
ER -