Tsuchiya Asuka, Yamana Hayato, Kawahara Takuya, Tsutsumi Yusuke, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo
Department of Clinical Epidemiology & Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center 280 Sakuranosato, Ibarakimachi, Higahi-Ibaraki-gun, Ibaraki 311-3193, Japan.
Department of Clinical Epidemiology & Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
Burns. 2018 Dec;44(8):1954-1961. doi: 10.1016/j.burns.2018.06.012. Epub 2018 Jul 3.
Tracheostomy is often performed in patients with severe burns who are undergoing prolonged mechanical ventilation. However, the appropriate timing of tracheostomy and its effect on mortality remain unknown. The aim of this study was to determine whether tracheostomy can reduce mortality in patients with severe burns.
Using the Japanese Diagnosis Procedure Combination database from April 2010 to March 2014, we extracted data on adult patients with severe burns (burn index score of ≥15) who started mechanical ventilation within 3days of admission. We estimated the hazard ratio for 28-day in-hospital mortality associated with tracheotomy performed from day 5 to 28. We adjusted for baseline and time-dependent confounders using inverse probability of treatment weighting methods and fitted a marginal structural Cox proportional hazard model.
We identified 680 eligible patients (94 in the tracheostomy group, 2289 person-days; 586 in the non-tracheostomy group, 11,197 person-days). Patients who underwent a tracheostomy had worse prognostic factors for mortality. After adjustment for these factors, the hazard ratio for 28-day mortality associated with tracheostomy compared with non-tracheostomy was 0.73 (95% confidence interval, 0.39-1.34).
There was no significant association between 28-day in-hospital mortality and early tracheostomy in adult patients with severe burns.
气管切开术常用于接受长时间机械通气的重度烧伤患者。然而，气管切开术的合适时机及其对死亡率的影响仍不清楚。本研究的目的是确定气管切开术是否能降低重度烧伤患者的死亡率。
利用2010年4月至2014年3月的日本诊断程序组合数据库，我们提取了入院3天内开始机械通气的成年重度烧伤患者（烧伤指数评分≥15）的数据。我们估计了第5天至第28天进行气管切开术与28天院内死亡率相关的风险比。我们使用治疗权重的逆概率方法对基线和时间依赖性混杂因素进行了调整，并拟合了边际结构Cox比例风险模型。
我们确定了680例符合条件的患者（气管切开术组94例，2289人日；非气管切开术组586例，11197人日）。接受气管切开术的患者有更差的死亡预后因素。在对这些因素进行调整后，与非气管切开术相比，气管切开术相关的28天死亡率的风险比为0.73（95%置信区间，0.39 - 1.34）。
在成年重度烧伤患者中，28天院内死亡率与早期气管切开术之间没有显著关联。
