title: Late tracheotomy is associated with higher morbidity and mortality in mechanically ventilated patients.
abstract: OBJECTIVE
  To determine whether the timing of tracheotomy placement impacts ventilation weaning status and mortality.
  
  
  METHODS
  Multi-institution retrospective cohort study.
  
  
  METHODS
  Demographic data, procedural details, and clinical outcomes were recorded for patients undergoing tracheotomy for prolonged mechanical ventilation across eight sites. The study group was divided into two groups: those undergoing tracheotomy within 14 days of initiation of mechanical ventilation and those undergoing tracheotomy at or after 14 days. Groups were compared for primary outcome measures of mortality and ability to wean from mechanical ventilation within the study period.
  
  
  RESULTS
  Of the 539 patients intubated for ventilator dependence with complete data available, 280 (51.9%) underwent tracheotomy within 14 days. Patients who underwent late tracheotomy were 1.72 times more likely to remain ventilator dependent during the follow-up period (95% confidence interval [CI]: 1.12-2.66), and had a 40% increased risk of death (odds ratio: 1.4, 95% CI: 0.96-1.99).
  
  
  CONCLUSIONS
  In this multicenter retrospective review of tracheotomy outcomes, late tracheotomy placement (>14 days) was associated with increased mortality and prolonged ventilator dependence. Standardized multidisciplinary management protocols for prolonged mechanical ventilation are recommended, and future work should confirm these results in a prospective manner.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, U.S.A.
authors.forename: Sapna A
authors.initials: SA
authors.lastname: Patel
authors.affiliation: University of Florida, Gainesville, Florida.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Plowman
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.
authors.forename: Stacey
authors.initials: S
authors.lastname: Halum
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, U.S.A.
authors.forename: Albert L
authors.initials: AL
authors.lastname: Merati
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, U.S.A.
authors.forename: Maya G
authors.initials: MG
authors.lastname: Sardesai
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014140:Tracheotomy / Q000009:adverse effects* / Q000379:methods; D014481:United States / Q000453:epidemiology
keywords: Tracheotomy; mortality; outcomes; prolonged ventilation; timing; weaning