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The Timing of Tracheostomy and Outcomes After Aneurysmal Subarachnoid Hemorrhage: A Nationwide Inpatient Sample Analysis

  • Hormuzdiyar H. Dasenbrock
  • Robert F. Rudy
  • William B. Gormley
  • Kai U. Frerichs
  • M. Ali Aziz-Sultan
  • Rose Du
Original Article
  • 62 Downloads

Abstract

Background

The goal of this study was to investigate the association of tracheostomy timing with outcomes after aneurysmal subarachnoid hemorrhage (SAH) in a national population.

Methods

Poor-grade aneurysmal SAH patients were extracted from the Nationwide Inpatient Sample (2002–2011). Multivariable linear regression was used to analyze predictors of tracheostomy timing and multivariable logistic regression was used to evaluate the association of timing of intervention with mortality, complications, and discharge to institutional care. Covariates included patient demographics, comorbidities, severity of subarachnoid hemorrhage (measured using the NIS-SAH severity scale), hospital characteristics, and other complications and length of stay.

Results

The median time to tracheostomy among 1380 poor-grade SAH admissions was 11 (interquartile range: 7–15) days after intubation. The mean number of days from intubation to tracheostomy in SAH patients at the hospital (p < 0.001) was the strongest predictor of tracheostomy timing for a patient, while comorbidities and SAH severity were not significant predictors. Mortality, neurologic complications, and discharge disposition did not differ significantly by tracheostomy time. However, later tracheostomy (when evaluated continuously) was associated with greater odds of pulmonary complications (p = 0.004), venous thromboembolism (p = 0.04), and pneumonia (p = 0.02), as well as a longer hospitalization (p < 0.001). Subgroup analysis only found these associations between tracheostomy timing and medical complications in patients with moderately poor grade (NIS-SAH severity scale 7–9), while there were no significant differences by timing of intervention in very poor-grade patients (NIS-SAH severity scale > 9).

Conclusions

In this analysis of a large, national data set, variation in hospital practices was the strongest predictor of tracheostomy timing for an individual. In patients with moderately poor grade, later tracheostomy was independently associated with pulmonary complications, venous thromboembolism, pneumonia, and a longer hospitalization, but not with mortality, neurological complications, or discharge disposition. However, tracheostomy timing was not significantly associated with outcomes in very poor-grade patients.

Keywords

Cerebral aneurysm Nationwide Inpatient Sample Subarachnoid hemorrhage Timing Tracheostomy 

Notes

Author contribution

HHD contributed to conception and design, acquisition of data, analysis and interpretation of data, drafting the article, critically revising the article, reviewed submitted version of the manuscript, and statistical analysis. RFR contributed to acquisition of data, analysis and interpretation of data, critically revising the article, reviewed submitted version of the manuscript, and statistical analysis. WBG contributed to analysis and interpretation of data, critically revising the article, reviewed submitted version of the manuscript, and administrative/technical/material support. KUF contributed to analysis and interpretation of data, critically revising the article, reviewed submitted version of the manuscript, and administrative/technical/material support. MAA-S contributed to analysis and interpretation of data, critically revising the article, reviewed submitted version of the manuscript, and administrative/technical/material support. RD contributed to conception and design, acquisition of data, analysis and interpretation of data, critically revising the article, reviewed submitted version of the manuscript, administrative/technical/material support, and study supervision.

Source of support

No funding.

Compliance with Ethical Standards

Conflict of interest

Hormuzdiyar H. Dasenbrock, Robert F. Rudy, Kai U. Frerichs, and Rose Du have nothing to disclose; M. Ali Aziz‑Sultan received consulting honoraria from Covidien and Codman; William B. Gormley received consulting honoraria from Codman.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA

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