Timing of Tracheostomy in Critically Ill Geriatric Trauma Patients: A Nationwide Analysis

Tracheostomy is frequently performed in trauma patients requiring prolonged mechanical ventilation. The optimal timing in older people, with limited physiologic reserve, remains unclear. Our study aims to evaluate whether early tracheostomy (ET) versus late tracheostomy (LT) is associated with differences in in-hospital complications and length of stay.

We conducted a retrospective cohort study using American College of Surgeons Trauma Quality Improvement Program (2017-2023) on geriatric trauma patients (≥65 years) who underwent ET with an injury severity score (≥9). Exclusions included in-hospital mortality, transfers, tracheostomy ≤48 h, or extubation ≤7 days. Patients were dichotomized into ET (≤7 d) and LT (>7 d) groups. Propensity score matching was performed in a 1:1 ratio to adjust for demographics, vitals, injury characteristics, operative interventions, flail chest, exploratory laparotomy, and mFI. Outcomes were complications, length of stay, ventilator days, and discharge disposition. A subanalysis on head trauma and thoracic trauma was performed.

A total of 3501 patients were included: 674 (19.3%) had ET and 2827 (80.7%) had LT. Median time to ET was 11 days. After propensity score matching, 442 remained in each group. There were significantly higher rates of unplanned intubation, intensive care unit (ICU) admission, and pressure ulcers (P < 0.001). LT had a more extended stay in the hospital and ICU and increased ventilator days (P < 0.001).

In critically ill geriatric patients, LT is associated with increased airway complications and extended hospital and ICU stays. This study supports planning ET in high-risk populations. To our knowledge, this is one of the largest national study evaluating ET timing in geriatric critically ill patients.