Journal Article

E-287 Predictors of tracheostomy and gastrostomy placement and long term outcomes in aneurysmal subarachnoid hemorrhage

Mahta, A, Taman, M, Chuck, C, Torabi, R, Moldovan, K, Oldam, J, Feler, J

2025

Overview

IntroductionAneurysmal subarachnoid hemorrhage (aSAH) has a high rate of morbidity. However, the ability to predict tracheostomy/gastrostomy tube requirement during hospital admission and long-term rates of tracheostomy/gastrostomy tube decannulation are not well understood.MethodsWe performed a retrospective study of patients with aSAH treated at a single center between 2015 and 2023, examining rates of tracheostomy and gastrostomy tube placement. Both univariate analysis and multivariate logistic regressions (MLR) were used to analyze predictors of tracheostomy/PEG placement, using characteristics present on hospital arrival such as age and Hunt and Hess [HH] grades. Additionally, rates and predictors post-discharge tracheostomy decannulation and PEG removal were also analyzed.ResultsOf 434 patients with aSAH reviewed, with 322 patients surviving to discharge (mean age, 56.7 ± 13.7; 62.7% female; 69.9% white), 17 (5.3%) had tracheostomy placement and 45 (13.9%) had gastrostomy tube placement. MLR showed that strong prediction of tracheostomy and PEG Placement (AUROC 0.87 and 0.82, respectively). On MLR, HH grade was predictive of both tracheostomy and G-tube placement (OR 2.9 95%CI [1.69, 5.4] and OR 2.2. 95%CI 1.5 and 3.2, respectively), with modified Fisher Score not associated with either tracheostomy but trending towards significance with gastrostomy tube placement (OR 2.3, 95% CI [0.9, 9.32] and OR 1.57, 95%CI [0.99, 2.69], p=0.07, respectively). Aneurysm re-rupture was predictive of PEG placement (OR 4.55, 95%CI [1.72, 11.9], p=0.002), while not tracheostomy (OR 1.67, 95% [0.32, 6.70], p=0.5). Age was not a predictor of either tracheostomy or PEG placement (OR 0.97, 95%CI [0.94, 1.01] and OR 0.99, 95%CI [0.97, 1.02], respectively).Tracheostomy decannulation was achieved in 52.9% (9/17), with 77.8% (7/9) of decannulations occurring within 3 months of discharge. Gastrostomy tube removal was achieved in 51.1% (23/45) of patients, with 56.5% (13/23) occurring with 3 months of discharge. On univariate analysis, age was not associated with tracheostomy decannulation (mean: 58.3 years [SD 13.] vs. 48.3 [?], p=0.3) or PEG removal (54 years [14.9] vs. 59.8 [13.6], p=0.19) but lower arrival HH grades and lower mRS at discharge follow-up were associated with PEG removal (HH grade median [IQR]: 3, [3, 4] vs. 4, [3, 5], p=0.03 and mRS at discharge median [IQR]: 5, [4, 5] vs. 5, [5, 5], p=0.05, respectively).ConclusionsTracheostomy or gastrostomy tube requirement could be accurately predicted using characteristics present on hospital arrival. Over half of patients with tracheostomies or gastrostomy tubes in our cohort were able to successfully have tracheostomy decannulation/gastrostomy tube removal, with half of those achieving this by 3 months of discharge. Neurologic status on arrival played a larger role than age in predicting tracheostomy/gastrostomy tube requirement and long-term tracheostomy decannulation/gastrostomy tube removal.DisclosuresC. Chuck: None. M. Taman: None. J. Oldam: None. J. Feler: None. K. Moldovan: None. R. Torabi: None. A. Mahta: None.

• Publisher: BMJ Publishing Group LTD
• Subject: Ostomy / Tracheotomy