title: Tracheostomy and invasive ventilation in Japanese ALS patients: decision-making and survival analysis: 1990-2010.
abstract: OBJECTIVE
  To evaluate the factors related to the choice of a tracheostomy and invasive ventilation in amyotrophic lateral sclerosis patients and to determine survival time after a tracheostomy at a single institute in Japan between 1990 and 2010.
  
  
  METHODS
  Data for survival time until death or tracheostomy were obtained from 160 patients. Fifty-two patients (33%) underwent tracheostomy/mechanical ventilation.
  
  
  RESULTS
  Tracheostomy and invasive ventilation prolonged median survival time (74 months), as did non-invasive ventilation (48 months) when compared to a non-ventilation-supported control group (32 months; p<0.001 each). The ratio of tracheostomy/mechanical ventilation in patients >65 years old significantly increased after 1999 (27%) compared to earlier years (10%, p=0.002). Cox proportional modeling confirmed an age of ≤65 years as advantageous for long-term survival after a tracheostomy. In univariate logistic regression analysis, factors related to the decision to perform a tracheostomy included an age of ≤65 years, greater use of non-invasive ventilation, the presence of a spouse, interval and speed from disease onset to diagnosis/tracheostomy and preservation of motor function. In multivariate logistic regression analysis, age, shorter duration from disease onset until tracheostomy and the presence of a spouse were independently associated with the decision to perform a tracheostomy. Kaplan-Meier plots revealed longer survival times in patients who resided at home after a tracheostomy compared to patients who stayed at a hospital (p=0.007).
  
  
  CONCLUSIONS
  Tracheostomy and invasive ventilation are frequently used in Japan. Various factors impact patients' decisions to have these procedures. This study identified factors related to the decision-making process and post-tracheostomy survival.
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: mu.tagami0728@gmail.com.
authors.forename: Muneyoshi
authors.initials: M
authors.lastname: Tagami
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1110@poh.osaka-med.ac.jp.
authors.forename: Fumiharu
authors.initials: F
authors.lastname: Kimura
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1045@poh.osaka-med.ac.jp.
authors.forename: Hideto
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1212@poh.osaka-med.ac.jp.
authors.forename: Shimon
authors.initials: S
authors.lastname: Ishida
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1291@poh.osaka-med.ac.jp.
authors.forename: Shinya
authors.initials: S
authors.lastname: Fujiwara
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1311@poh.osaka-med.ac.jp.
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Doi
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1237@poh.osaka-med.ac.jp.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Hosokawa
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1303@poh.osaka-med.ac.jp.
authors.forename: Kazushi
authors.initials: K
authors.lastname: Yamane
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1287@poh.osaka-med.ac.jp.
authors.forename: Kiichi
authors.initials: K
authors.lastname: Unoda
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1371@poh.osaka-med.ac.jp.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Hirose
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1372@poh.osaka-med.ac.jp.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tani
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1385@poh.osaka-med.ac.jp.
authors.forename: Shin
authors.initials: S
authors.lastname: Ota
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1017@poh.osaka-med.ac.jp.
authors.forename: Takumi
authors.initials: T
authors.lastname: Ito
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1052@poh.osaka-med.ac.jp.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Sugino
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1027@poh.osaka-med.ac.jp.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Shinoda
authors.affiliation: Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: hanafusa@poh.osaka-med.ac.jp.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Hanafusa
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000401:mortality / Q000523:psychology / Q000628:therapy; D003657:Decision Making; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016019:Survival Analysis; D014139:Tracheostomy / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: ALSFRS-R; Long-term care insurance; NIPPV motor function phenotype; Retrospective study