Early versus late tracheostomy in trauma patients: Insights from the National Trauma Data Bank

Critically injured trauma patients often require prolonged mechanical ventilation and intensive care. Tracheostomy facilitates ventilator weaning and transition to chronic care, yet timing varies widely. We compared trauma patients undergoing early versus late tracheostomy and examined clinical outcomes.

The National Trauma Data Bank (2017-2023) was queried for adult patients undergoing tracheostomy. Exclusions included burn patients, missing timing data, emergency department deaths, and transfers. Early tracheostomy was defined as ≤7 days from admission. Patient characteristics were compared. Outcomes included prolonged intensive care unit stay (≥20 days), prolonged mechanical ventilation (≥16 days), prolonged ventilator weaning (>7 days), ventilator-associated pneumonia, discharge home, and mortality. Multivariable logistic regression and propensity score-matched sensitivity analyses were performed.

Among 61,555 eligible trauma patients undergoing tracheostomy, 20,080 (32.6%) underwent early tracheostomy. Early tracheostomy patients were younger (median age, 39 vs 50 years; P < .001), more often male (80.6% vs 76.4%, P < .001), had lower injury severity, and fewer comorbidities. After adjustment, early tracheostomy was associated with shorter intensive care unit stay (odds ratio, 0.18; 95% confidence interval, 0.17-0.19; P < .001), fewer ventilator days (odds ratio, 0.20; 95% confidence interval, 0.19-0.21; P < .001), lower odds of prolonged ventilator weaning (odds ratio, 0.79; 95% confidence interval, 0.76-0.83; P < .001), less ventilator-associated pneumonia (odds ratio, 0.51; 95% confidence interval, 0.48-0.55), and higher odds of discharge home (odds ratio, 2.27; 95% confidence interval, 2.14-2.40), but increased mortality (odds ratio, 1.36; 95% confidence interval, 1.25-1.49; P < .001). Propensity-matched analysis demonstrated a persistent 2.0% absolute mortality difference.

Early tracheostomy was associated with improved intensive care unit and ventilator efficiency and greater likelihood of discharge home, despite modestly higher mortality, underscoring the complexity of timing decisions.