title: Tracheostomy timing affects stroke recovery.
abstract: BACKGROUND
  The timing of tracheostomy in stroke patients unable to protect their airway has become a topic of debate. Proponents for early tracheostomy (ET) cite benefits including less ventilation-associated pneumonia, less sedative drug use, shorter length of stay, and reduced mortality in comparison with late tracheostomy (LT).
  
  
  METHODS
  We examined the timing of tracheostomy on stroke patient outcomes across the United States using the Nationwide Inpatient Sample (2008-2010). Independent samples t tests and chi-squared tests were used to make comparisons between early (≤10 days) and late (11-25 days) tracheostomy. Multivariable models, adjusted for confounding factors, investigated outcome measures.
  
  
  RESULTS
  In total, 13,165 stroke cases were included in the study (5591 in the ET group and 7574 in the LT group). Patients receiving an ET had a significant reduction in the odds of ventilator-associated pneumonia in comparison with the LT group (OR: .688, P = .026). The length of stay for patients receiving an ET was significantly lower in comparison with the LT group (P < .001) and was associated with an 18% reduction in total hospital costs (P < .001).
  
  
  CONCLUSIONS
  Early tracheostomy for stroke patients may reduce the incidence of ventilator-associated pneumonia, thereby shortening the hospital stay and lowering total hospital costs. These relationships warrant further investigation in a large prospective multicenter trial.
authors.affiliation: Department of Otolaryngology, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Villwock
authors.affiliation: Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Villwock
authors.affiliation: Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York. Electronic address: deshaiee@upstate.edu.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Deshaies
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017046:Cost Savings; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D053717:Pneumonia, Ventilator-Associated / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D061665:Time-to-Treatment; D014139:Tracheostomy / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Tracheostomy; neurocritical care; outcome; stroke; tracheostomy timing