Comparison of early versus late tracheostomy in trauma patients: a multicenter propensity score-matched cohort study

Tracheostomy is commonly performed to facilitate airway management in critically ill trauma patients. It may also reduce the duration of mechanical ventilation (MV); however, the optimal timing remains uncertain. This study compared clinical outcomes between early and late tracheostomy in trauma patients. A total of 220 adult patients who underwent tracheostomy following endotracheal intubation at two regional trauma centers between January 2019 and December 2022 were retrospectively reviewed. Patients were categorized into early (≤ 7 days after intubation) and late (> 7 days) tracheostomy groups. Outcomes included MV duration, intensive care unit (ICU) length of stay (LOS), hospital LOS, ventilator-free days (VFDs), and in-hospital mortality. Baseline differences were adjusted for using propensity score matching (PSM). After PSM, early tracheostomy was associated with shorter hospital LOS (median [interquartile range], 44.0 [26.5-68.5] vs. 59.0 [29.0-78.5]; P = 0.038), ICU LOS (22.0 [15.0-37.8] vs. 28.0 [20.0-38.5]; P = 0.047), and MV duration (11.5 [6.3-18.5] vs. 20.0 [14.0-27.8]; P < 0.001), as well as more VFDs (13.5 [0.0-20.0] vs. 4.0 [0.0-13.0]; P = 0.002). In-hospital mortality did not differ significantly (20.0 vs. 20.0%; P = 1.000). Early tracheostomy was associated with shorter MV duration, more VFDs, and reduced ICU and hospital LOS without a mortality benefit, suggesting potential advantages in selected patients requiring prolonged MV.