Timing of Gastrostomy Relative to Tracheostomy After Complete Cervical Spinal Cord Injury: Impact on Hospitalization Outcomes and Complication Rates.

Abstract

Tracheostomy and gastrostomy are frequently performed to facilitate prolonged ventilation and nutritional support in spinal cord injury (SCI) patients. The aim of this study was to evaluate the impact of gastrostomy timing relative to tracheostomy on in-hospital outcomes and complications in complete traumatic cervical SCI patients. A multicenter retrospective observational study was performed using data from the Trauma Quality Improvement Program of the American College of Surgeons, between 2010 and 2020. The study included complete traumatic cervical SCI patients who underwent both tracheostomy and gastrostomy. Gastrostomy timing was categorized relative to tracheostomy timing as same-day (within 24 hours of tracheostomy) and delayed (more than 24 hours after tracheostomy). Outcomes of interest included intensive care unit (ICU) and hospital length of stay (LOS), mechanical ventilation duration, incidence of major in-hospital complications, immobility complications, and surgical site infections. Univariate and multivariable models were constructed to assess associations. We conducted a sensitivity analysis using propensity score matching to determine the robustness of our findings. Of 2958 patients included, 2168 underwent same-day tracheostomy and gastrostomy and 790 underwent delayed gastrostomy after tracheostomy. Patients in the same-day group had significantly shorter ICU and hospital LOS and reduced mechanical ventilation duration (adjusted mean difference [MD] -5.83, 95% CI -7.51 to -4.16, P < .001, adjusted MD -8.98, 95% CI -11.33 to -6.63, P < .001, and adjusted MD -5.93, 95% CI -7.80 to -4.07, P < .001, respectively). No evident difference was noted in the occurrence of major hospital adverse events between the groups. The sensitivity analysis recapitulated the primary analysis findings, demonstrating the consistency and robustness of effect estimates. Same-day tracheostomy and gastrostomy in complete traumatic cervical SCI patients was associated with better outcomes than delayed gastrostomy. Specifically, grouping these procedures may shorten ICU and overall hospital LOS, and reduce ventilation duration.