老年孤立性严重脑外伤患者的气管切开时机：全国性分析

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2024-11-22 DOI:10.1016/j.amjsurg.2024.116100

Omar I. Morales Rosario , Emanuele Lagazzi , Vahe S. Panossian , Josip Plascevic , Yasmin Arda , May Abiad , Ikemsinachi Nzenwa , George C. Velmahos , John O. Hwabejire

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引用次数: 0

摘要

背景在老年创伤性脑损伤（TBI）患者中，气管切开时间对预后的影响尚不明确。方法在 ACS-TQIP 2017-2020 数据库中识别了年龄≥65 岁、接受气管切开术的孤立性严重 TBI 患者。患者按早期（<10 天）与晚期（≥10 天）气管切开术分组。倾向评分匹配考虑了混杂因素。结果包括死亡率、住院时间（H-LOS）和重症监护室住院时间（ICU-LOS）、呼吸机使用天数和并发症。结果在1385名患者中，637人（46.0%）接受了早期气管切开术。经过倾向评分匹配，早期气管切开术与缩短 H-LOS （18 天 vs. 25 天，p < 0.001）、ICU-LOS（14 天 vs. 20 天，p < 0.001）和减少呼吸机天数（12 天 vs. 17 天，p < 0.001）有关。此外，早期气管切开组的深静脉血栓发生率较低（6.7 % vs. 11.3 %，p = 0.024），但死亡率相似（11.1 % vs. 9.5 %，p = 0.48）。

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Timing of tracheostomy in geriatric patients with isolated severe traumatic brain injury: A nationwide analysis

Background

The impact of tracheostomy timing on outcomes is unclear in geriatric patients with traumatic brain injury (TBI).

Methods

Patients aged≥65 with isolated severe TBI who underwent tracheostomy were identified in the ACS-TQIP 2017–2020 database. Patients were grouped by early (<10 days) vs. late (≥10 days) tracheostomy. Propensity score matching accounted for confounders. Outcomes included mortality, hospital (H-LOS) and ICU length of stay (ICU-LOS), ventilator days, and complications.

Results

Among 1385 patients, 637 (46.0 %) had an early tracheostomy. Following propensity score matching, early tracheostomy was associated with shorter H-LOS (18 vs. 25 days, p < 0.001), ICU-LOS (14 vs. 20 days, p < 0.001), and fewer ventilator days (12 vs. 17 days, p < 0.001). Furthermore, the incidence of deep vein thrombosis was lower in the early tracheostomy group (6.7 % vs. 11.3 %, p = 0.024), but mortality rates were similar (11.1 % vs. 9.5 %, p = 0.48).

Conclusion

Early tracheostomy in geriatric patients with isolated severe TBI is associated with reduced LOS, ventilator days, and complications, suggesting potential benefits of earlier intervention.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.