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Determination of the length of hospital stay in III critically III patients after early tracheostomy in the Puerto Rico Trauma Hospital.

Objective: There is a debate regardingthe timing of tracheostomy in trauma patients. This study aimed to assess the effect of early tracheostomy (ET; [less than or equal to] 7 days) in the outcomes associated to hospital stay. Methods: A historical cohort study was undertaken using charts of patients admitted to Puerto Rico Trauma Hospital (PRTH) who required mechanical ventilation (MV) and underwent tracheostomies, 2000-2013. A logistic regression was done to evaluate the association between timing of tracheostomy vs. complications and mortality ratio. To estimate the relationship between ET and outcomes related to hospital stay, a binomial-negative regression was performed. A p<0.05 was considered statistically significant. This study was IRB approved: B0030714. Results: A total of 1,134 patients were evaluated; 313 of whom were ETs and 821, late tracheostomies (LTs). ET patients had a lower ISS compared to their counterparts (p=0.004). ET patients showed lower complications (Respiratory Failure OR=0.61, CI95%: 0.45-0.84; ARDS OR=0.44, CI95%: 0.300.64; Pneumonia OR=0.53, CI95%: 0.40-0.71; Septicemia OR=0.48, CI95%: 0.33-0.70; Bacteremia OR=0.59, CI95%: 0.40-0.86) than LT patients. Those with ET had lower MV days (RRadj.=0.74, CI95%: 0.68-0.82), ICU days (RRadj.=0.66, CI95%: 0.59-0.73), and LOS (RRadj.=0.74, CI95%: 0.69-0.80) compared to those with LT, after adjusting by age, ISS, and complications. However, there were no differences in mortality rate (ORadj.=0.66, CI95%: 0.44-1.01) among ET and LT patients, after adjusting for confounders. Conclusion: Our results suggested that ET reduced complications, MV days, ICU days, and LOS, having an indirect effect on mortality ratio. Standardized protocols of ET are recommended to enhance health outcomes in trauma patients.

Ana M. Romero (3); Omar Garcia, DrPH (2); Ediel Ramos, MPH (2); Pablo Rodriguez-Ortiz, MD, FACS, FCCM, FACP, FCCP (1,2)

(1) Department of Surgery, School of Medicine, University of Puerto Rico, San Juan, PR; (2) Puerto Rico Trauma Hospital, San Juan, PR; (3) Department of Biology, University of Puerto Rico, Rio Piedras Campus, San Juan, PR

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Author:Romero, Ana M.; Garcia, Omar; Ramos, Ediel; Rodriguez-Ortiz, Pablo
Publication:Puerto Rico Health Sciences Journal
Date:Jun 1, 2015
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