(A739) The Impact of Time to Tracheostomy Placement on Covid-19 morbidity and mortality

Introduction: The emergence of COVID-19 significantly impacted critical care and otolaryngology practices. While COVID-19 patients are often at high risk for intubation, the optimal timing for tracheostomy remains unclear in the literature.

Methods: The National (Nationwide) Inpatient Sample (NIS) database was used to identify patients who underwent tracheostomy in 2019-2020. Patients were selected based on ICD-10 codes for tracheostomy placement and were then stratified by COVID-19 diagnosis. Tracheostomy placement timing was recorded relative to the duration between intubation and tracheostomy, with patients categorized into early, standard, and late groups. Demographic and clinical characteristics, including comorbidities, were also extracted for analysis.

Results: Among 21,000 patients who underwent tracheostomy, 3,715 were diagnosed with COVID-19. Of these, 2,972 underwent tracheostomy more than 15 days after intubation, with a mortality rate of 25.8% (n = 767, 95% CI: [24.5%, 27.1%]). The mortality rate in the standard group, which included 434 patients, was 33.2% (n = 144, 95% CI: [30.0%, 36.4%]). In the early group, consisting of 296, the mortality rate was 31.4% (n = 93, 95% CI: [27.6%, 35.2%]). Regression analysis identified significant risk factors for increased mortality (p < 0.05), including age, hypothyroidism, depression, obesity, and diabetes without chronic complications.

Conclusions: Most tracheostomies were performed more than 15 days after intubation, with the fewest occurring within 7 days. The late tracheostomy cohort had the lowest mortality rate compared to the standard and early cohorts. Several comorbidities were significantly associated with higher mortality rates. While much of the existing literature supports early tracheostomy to improve outcomes, these findings suggest that later tracheostomy may be associated with better survival in certain COVID-19 patients. Additional research is needed to reconcile these differences, identify optimal timing, and determine patient-specific factors influencing outcomes.