NYMC Faculty Publications

Early Tracheostomy in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke

Authors

Smit Shah, Department of Neurology, University of South Carolina/PRISMA Health Richland, Columbia, SC, United States of America.
Eris Spirollari, School of Medicine, New York Medical College, Valhalla, NY, United States of America.
Christina Ng, School of Medicine, New York Medical College, Valhalla, NY, United States of America.
Kevin Cordeiro, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America.
Kevin Clare, Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
Bridget Nolan, Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
Alexandria F. Naftchi, School of Medicine, New York Medical College, Valhalla, NY, United States of America.
Austin B. Carpenter, Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
Jose F. Dominguez, Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America. Electronic address: Jose.Dominguez@wmchealth.org.
Ian Kaplan, Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
Brittany Bass, Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
Emily Harper, Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
Jon Rosenberg, Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
Dipak Chandy, Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
Stephan A. Mayer, Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
Kartik Prabhakaran, Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
Arthur Wang, Department of Neurosurgery, Tulane University Medical Center, New Orleans, LA, United States of America.
Chirag D. Gandhi, Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America.
Fawaz Al-Mufti, Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, United States of America. Electronic address: Fawaz.Al-Mufti@wmchealth.org.

Author Type(s)

Student, Resident/Fellow, Faculty

Journal Title

Journal of Critical Care

First Page

154357

Document Type

Article

Publication Date

12-1-2023

Department

Neurosurgery

Second Department

Medicine

Third Department

Neurology

Abstract

PURPOSE: Respiratory failure following mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is a known complication, and requirement of tracheostomy is associated with worse outcomes. Our objective is to evaluate characteristics associated with tracheostomy timing in AIS patients treated with MT. METHODS: The National Inpatient Sample was queried for adult patients treated with MT for AIS from 2016 to 2019. Baseline demographic characteristics, comorbidities, and inpatient outcomes were analyzed for associations in patients who received tracheostomy. Timing of early tracheostomy (ETR) was defined as placement before day 8 of hospital stay. RESULTS: Of 3505 AIS-MT patients who received tracheostomy, 915 (26.1%) underwent ETR. Patients who underwent ETR had shorter length of stay (LOS) (25.39 days vs 32.43 days, p < 0.001) and lower total hospital charges ($483,472.07 vs $612,362.86, p < 0.001). ETR did not confer a mortality benefit but was associated with less acute kidney injury (OR, 0.697; p = 0.013), pneumonia (OR, 0.449; p < 0.001), and sepsis (OR, 0.536; p = 0.002). CONCLUSION: An expected increase in complications and healthcare resource utilization is seen in AIS-MT patients receiving tracheostomy, likely reflecting the severity of patients' post-stroke neurologic injury. Among these high-risk patients, ETR was predictive of shorter LOS and fewer complications.

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