Timing of Tracheostomy After Anterior Cervical Decompression in Traumatic Cervical Spinal Cord Injury: A Systematic Review and Meta-Analysis.

Abstract

Compare early versus late tracheostomy after anterior cervical decompression in traumatic cervical spinal cord injury for effects on in-hospital outcomes. In concordance with PRISMA guidelines, PubMed (MEDLINE), Embase, and Google Scholar were searched. Inclusion was adults with traumatic cervical spinal cord injury undergoing anterior decompression with postoperative tracheostomy timing harmonized. Primary outcomes were in-hospital mortality, duration of mechanical ventilation, and intensive care unit (ICU) length of stay (LOS). Secondary outcomes were pneumonia and anterior cervical surgical-site infection (SSI). Meta-analysis was performed using a random-effects model. Mean differences (MDs) were for continuous outcomes, odds ratios (ORs) for dichotomous outcomes, and heterogeneity with I². Fourteen studies were included (N = 693). Three comparative cohorts (N = 210) contributed data for duration of mechanical ventilation, ICU LOS, and anterior SSI. Four cohorts (N = 308) contributed mortality data. Early tracheostomy was associated with a shorter duration of mechanical ventilation compared with late tracheostomy (MD -5.3 days; 95% CI -6.33 to -4.28; I² = 0%). ICU LOS was also shorter in the early group with high heterogeneity (MD -5.4 days; 95% CI -10.65 to -0.18; I² = 63%). Mortality (OR 1.64; 95% CI 0.38-7.06; I² = 61%) and anterior SSI rates (OR 0.32; 95% CI 0.06-1.59; I² = 0%) did not differ between groups. In anterior cervical decompression cohorts, our results in early tracheostomy were associated with reduced ventilator days and ICU LOS with no observed risk to SSI. Larger prospective, surgery-specific studies with standardized timing and definitions are needed.