Risk Factors for Tracheostomy and Effect of Tracheostomy Timing on Outcome in the Elderly Critically Ill Surgical Patient

Background: Controversy remains regarding optimal timing of tracheostomy (T). We performed a retrospective cohort study to determine if there was any benefit to early T; independent risk factors for T were also to be determined. Methods: ICU patients on mechanical ventilation (MV) from March 2004 - 2006 (n = 651) were extracted from our ICU database, with 114 patients undergoing a T. Outcomes for early (E) (≤ 10 d) T vs. late (L) (> 10 d) T were compared. A multivariate analysis was performed with the presence or absence of T being the dichotomous dependent variable. Data are presented as median (25th, 75th percentile). Results: Compared with patients who did not require a T, those who did were older and had higher APACHE II scores; they also had an increased incidence of CHF, vasopressor dependence, and being on the neurosurgical service. Both ICU LOS and hospital LOS were significantly lower in group E vs. group L. Conclusions: In our cohort of elderly, critically ill, surgical patients, benefits associated with early T included decreases in ICU and hospital length of stay. Risk factors for T included a history of CHF, being a NSG, and MV > 5 days.