同步气管切开术和胃造口术可缩短创伤性脑损伤患者的住院时间。
Synchronous tracheostomy and gastrostomy placement results in shorter length of stay in traumatic brain injury patients.
作者信息
Hochu Gabrielle, Soule Sara, Lenart Emily, Howley Isaac W, Filiberto Dina, Byerly Saskya
机构信息
College of Medicine, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN, 38103, USA.
Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN, 38103, USA.
出版信息
Am J Surg. 2024 Jan;227:153-156. doi: 10.1016/j.amjsurg.2023.10.012. Epub 2023 Oct 16.
BACKGROUND
American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines recommend gastrostomy for patients suspected to require enteral access device for 4-6 weeks. Our hypothesis was that traumatic brain injury (TBI) patients undergoing synchronous tracheostomy/gastrostomy (SYNC) compared to tracheostomy first (DELAY) have shorter length of stay (LOS) but higher rates of unnecessary gastrostomy.
METHODS
Retrospective review of TBI patients requiring tracheostomy in 2017-2022 at a Level 1 trauma center was conducted. SYNC and DELAY patients were compared, and CoxPH analysis was performed for LOS.
RESULTS
394 patients were included [mean age: 42 (SD:18); mortality: 9 %]. The DELAY group had longer LOS (39 vs 32 days, p < 0.001). There was no significant difference in unnecessary gastrostomy rate between groups (p = 0.1331). In adjusted hazard analysis, SYNC predicted shorter LOS (HR:1.54; 95 % CI:1.20-1.98, p < 0.001).
CONCLUSIONS
Synchronous gastrostomy was associated with shorter length of stay and similar rates of unnecessary gastrostomy in TBI patients.
背景
美国肠外和肠内营养学会（ASPEN）指南建议，对于疑似需要肠内通路装置4 - 6周的患者行胃造口术。我们的假设是，与先行气管切开术（延迟组）相比，同时行气管切开术/胃造口术（同步组）的创伤性脑损伤（TBI）患者住院时间更短，但不必要胃造口术的发生率更高。
方法
对2017 - 2022年在一级创伤中心需要气管切开术的TBI患者进行回顾性研究。比较同步组和延迟组患者，并对住院时间进行CoxPH分析。
结果
纳入394例患者[平均年龄：42岁（标准差：18）；死亡率：9%]。延迟组住院时间更长（39天对32天，p < 0.001）。两组间不必要胃造口术发生率无显著差异（p = 0.1331）。在调整风险分析中，同步组预测住院时间更短（风险比：1.54；95%置信区间：1.20 - 1.98，p < 0.001）。
结论
同步胃造口术与TBI患者住院时间缩短及不必要胃造口术发生率相似有关。
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