Introduction: The optimal timing of tracheostomy in mechanically ventilated patients remains controversial, particularly among those with acute respiratory distress syndrome (ARDS).
Methods: Using 2022 National Inpatient Sample data, we assessed in-hospital mortality and length of stay (LOS) among intubated ARDS patients aged >18 who underwent tracheostomy. Patients were categorized into five groups by timing of tracheostomy: very early (≤4 days post-intubation), early (days 5-7), intermediate (days 8-10), intermediately late (days 11-14), and late (>14 days). Multivariable analyses adjusted for demographics, socioeconomic factors, hospital characteristics, and key comorbidities.
Results: A total of 6,720 intubated ARDS patients underwent tracheostomy: 10.3% very early, 8.5% early, 10.3% intermediate, 18.5% intermediately late, and 52.5% late.
In-hospital mortality rates for very early, early, intermediate, intermediately late, and late tracheostomy groups were 27.5%, 21.9%, 23.9%, 28.2%, and 26.9%, respectively. After adjustment, no significant mortality differences were found compared to the very early group: early (OR 0.853, p=0.617), intermediate (OR 0.855, p=0.618), intermediately late (OR 1.062, p=0.818), and late (OR 0.978, p=0.923). Similar findings were observed when using alternative reference groups; there were no significant differences in mortality across the five tracheostomy timing categories.
Mean LOS was 43.8 days (very early), 41.4 (early), 44.0 (intermediate), 41.0 (intermediately late), and 55.8 (late). Late tracheostomy was significantly associated with a longer LOS compared to all other groups: +11.6 days vs. very early (p < 0.001), +15.1 vs. early (p < 0.001), +11.9 vs. intermediate (p < 0.001), and +14.6 vs. intermediately late (p < 0.001). No statistically significant differences in LOS were found when comparing the other four groups to each other.
Conclusions: Among intubated ARDS patients, tracheostomy timing was not associated with differences in in-hospital mortality. However, late tracheostomy performed after 14 days was associated with a significantly longer hospital LOS compared to earlier tracheostomy groups, suggesting potential benefits of earlier intervention for reducing resource utilization.
