Early versus Late Tracheostomy in Critically Injured Burn Survivors: A National, Multi-Database Analysis.

Abstract

Tracheostomy is indicated in critically ill patients when prolonged mechanical ventilation is anticipated. We leveraged national data to evaluate tracheostomy timing in burn patients, hypothesizing that early tracheostomy would be associated with reduced length of stay (LOS) and ventilator-associated pneumonia (VAP). Surviving burn encounters undergoing tracheostomy in three national databases-Nationwide Inpatient Sample (NIS), 2016-2021, National Trauma Data Bank (NTDB), 2007-2014, and Burn Care Quality Platform (BCQP), 2015-2022-were stratified by tracheostomy timing relative to admission: early: ≤ 10 days versus late: > 10 days. Early tracheostomy encounters were propensity-score-matched with late tracheostomy encounters on age, sex, and total body surface area (TBSA) of burns to evaluate the impact of tracheostomy timing on LOS, ICU LOS, ventilator days, VAP, discharge to inpatient rehabilitation, and discharge to long term acute care (LTAC). 9,173 burn encounters underwent tracheostomy (6,255 in NIS, 1,332 in NTDB, and 1,586 in BCQP) of which 51.1% were early. Within matched cohorts, early tracheostomy was associated with shorter LOS, reported as Average Treatment Effect, in days [95% CI]: NIS: -22.9 [-32.8- -13.1], p<0.01; NTDB: -12.7 [-18.7- -6.8], p<0.01; BCQP: -7.0 [-12.5- -1.5], p<0.01. Early tracheostomy was associated with shorter ICU LOS and fewer ventilator days in NTDB and BCQP (p<0.04). Early tracheostomy was not associated with discharge to inpatient rehabilitation or VAP. Early tracheostomy decreased discharge to LTAC in NTDB and BCQP (p≤0.02). Our multi-database analysis supports early tracheostomy in critically injured burn patients requiring prolonged mechanical ventilation.