Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
World Neurosurg. 2019 Nov;131:e606-e613. doi: 10.1016/j.wneu.2019.08.013. Epub 2019 Aug 10.
In the present study, we sought to evaluate the timing and outcomes in patients with hemorrhagic stroke who received tracheostomy.
A retrospective database search was undertaken to identify patients with hemorrhagic stroke between January 2010 and December 2018. Clinical data on basic demographics, clinical features, and outcomes were extracted. The primary outcome was in-hospital mortality and secondary outcomes were hospital stays and hospital costs. Univariate and multivariate analyses were used to compare the characteristics and outcomes between patients with hemorrhagic stroke who underwent tracheostomy early (days 1-6) and late (days 7 or later).
A total of 425 patients were identified, 74.4% (n = 316) received an early tracheostomy during the hospitalization. Patients with hemorrhagic stroke who received early tracheostomy had a higher rate of neurosurgical operation (odds ratio, 2.77; 95% confidence interval, 1.54-4.99; P = 0.001) and different types of hemorrhagic stroke (P = 0.001) in comparison with the late tracheostomy patients. In addition, early tracheostomy was associated with shorter hospital stays (odds ratio, 1.02; 95% confidence interval, 1.01-1.03; P = 0.003) and reduced hospital costs (P < 0.001) than with late tracheostomy. However, no significant difference was observed with regard to in-hospital mortality between early and late tracheostomy groups (P = 0.744).
In our cohort, early tracheostomy in patients with hemorrhagic stroke may help reduce hospital stays and hospital costs, but not in-hospital mortality. Future prospective multicenter studies are warranted to validate these findings.
本研究旨在评估接受气管切开术的出血性卒中患者的时机和结局。
回顾性数据库检索 2010 年 1 月至 2018 年 12 月期间的出血性卒中患者。提取基本人口统计学、临床特征和结局的临床数据。主要结局为院内死亡率，次要结局为住院时间和住院费用。采用单因素和多因素分析比较早期（第 1-6 天）和晚期（第 7 天或以后）行气管切开术的出血性卒中患者的特征和结局。
共纳入 425 例患者，74.4%（n=316）在住院期间接受早期气管切开术。与晚期气管切开术患者相比，接受早期气管切开术的出血性卒中患者行神经外科手术的比例更高（优势比，2.77；95%置信区间，1.54-4.99；P=0.001），且出血性卒中的类型不同（P=0.001）。此外，与晚期气管切开术相比，早期气管切开术与较短的住院时间（优势比，1.02；95%置信区间，1.01-1.03；P=0.003）和降低的住院费用（P<0.001）相关。然而，早期和晚期气管切开术组的院内死亡率无显著差异（P=0.744）。
在本队列中，出血性卒中患者的早期气管切开术可能有助于缩短住院时间和降低住院费用，但不能降低院内死亡率。需要未来进行前瞻性多中心研究来验证这些发现。
