Delayed Tracheostomy After Cervical Fixation is Not Associated With Improved Outcomes: A Trauma Quality Improvement...

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Otolaryngology

Background:

• Unstable cervical spine fractures pose a significant risk of respiratory failure.
• Optimal timing for tracheostomy following operative cervical fixation (OCF) remains debated.
• This study investigates the impact of tracheostomy timing on surgical site infections (SSIs) in OCF patients.

Purpose of the Study:

• To evaluate the relationship between tracheostomy timing and SSIs in patients undergoing OCF.
• To determine if early tracheostomy (<7 days) impacts SSI rates compared to delayed tracheostomy (≥7 days).
• To assess the association of tracheostomy timing with ICU LOS, ventilator days, and overall hospital LOS.

Main Methods:

• Analysis of the Trauma Quality Improvement Program (TQIP) database (2017-2019).
• Inclusion of patients with isolated cervical spine injuries undergoing OCF and tracheostomy.
• Comparison of early (<7 days) versus delayed (≥7 days) tracheostomy using logistic regression and Pearson correlations.

Main Results:

• No significant difference in SSI rates between early (1.6%) and delayed (1.2%) tracheostomy groups (P = .5077).
• Delayed tracheostomy was associated with increased ICU LOS, ventilator days, and hospital LOS.
• Increased time to tracheostomy correlated with higher morbidity and longer lengths of stay.

Conclusions:

• Delayed tracheostomy after OCF does not increase SSI risk.
• Early tracheostomy is associated with reduced ICU LOS, ventilator days, and overall hospital LOS.
• Findings support current guidelines recommending against delaying tracheostomy due to SSI concerns.