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Impact of Early Tracheostomy on Hospital-Acquired Pneumonia and Infection of Anterior Cervical Fusion Site in Patients with Acute Cervical Cord Injury
Original Article

Korean J Nutr 2012;8(2):59-63.

Published online: 19 January 2012

DOI: https://doi.org/10.13004/kjnt.2012.08.0.59

Impact of Early Tracheostomy on Hospital-Acquired Pneumonia and Infection of Anterior Cervical Fusion Site in Patients with Acute Cervical Cord Injury

Han Jin Jang, MD, Cheol Su Jwa, MD

Department of Neurosurgery, National Medical Center, Seoul, Korea

Address for correspondence: Cheol Su Jwa, MD Department of Neurosurgery, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul 100-799, Korea Tel: +82-2-2260-7185, Fax: +82-2-2262-4869 E-mail: chsjwa@hanmail.net

Received 19 February 2012       Revised 30 March 2012       Accepted 30 March 2012

Copyright © 2012 The Korean Nutrition Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective:

We tried to investigate impact of early tracheostomy on hospital-acquired pneumonia and infection of anterior cervical fusion site in patients with acute cervical cord injury undergoing respiratory difficulty.

Methods:

A retrospective analysis was done with 42 subjects received tracheostomy of patients with acute cervical cord injury admitted in our institution from Jan. 2001 to Dec. 2010. The subjects were classified into early tracheostomy group (≤7 days after endotracheal intubation) and delayed (＞7 days). We analyzed the incidence of post-tracheostomy pneumonia, intensive care unit (ICU) stay, hospital stay, in-hospital mortality and tracheostomy or anterior cervical fusion site infections.

Results:

Early tracheostomy was performed in 13 patients (31.0%) and delayed in 29 (69.0%). The incidence of post-tracheostomy pneumonia was significantly lower in the early tracheostomy group than in the delayed (p=0.018). ICU stay was also significantly lower in the early tracheostomy group than in the delayed (p=0.013). Hospital stay was lower in the early tracheostomy group than in the delayed (p=0.061), but was not statistically significant. In-hospital mortality was not different between two groups. There were no patients with infection of anterior cervical fusion site as a consequence of tracheostomy in both groups.

Conclusion:

This study suggests that early tracheostomy may have beneficial effects in patients with acute cervical cord injury. Tracheostomy was not found to increase the risk of infection in previous anterior cervical surgery.

Keywords: Outcome, Spinal cord injury, Tracheostomy

REFERENCES

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TABLE 1.
Characteristics and outcome of 42 patients with cervical cord injury based on timing of tracheostomy
Tracheostomy
  Early (≤7 d) Delayed (＞7 d) p
Total subjects: 42 (%) 13 (31.0) 29 (69.0)  
Age, years (±SD) Sex, male (%) 42.1 (11.9) 11 (84.6) 43.5 (12.2) 25 (86.2) 0.747 0.892
Causes      
Falling accident (%) 9 (69.2) 17 (58.6) 0.733
Traffic accident (%) 4 (30.8) 12 (41.4)  
Anterior cervical fusion surgery (%) 8 (61.5) 21 (72.4) 0.481
APACHE II (±SD) 6.2 (5.1) 5.3 (3.7) 0.513
Associated injuries (%) 5 (38.5) 13 (48.8) 0.748
Cervical cord injury level     0.739
C1-C4 (%) 5 (38.5) 14 (48.3)  
C5-C8 (%) 8 (61.5) 15 (51.7)  
ASIA impairment scale, initial     0.329
A (%) 2 (15.4) 1 (3.4)  
B (%) 4 (30.8) 9 (31.0)  
C (%) 4 (30.8) 15 (51.7)  
D (%) 3 (23.1) 4 (13.8)  
Post-tracheostomy pneumonia (%) 4 (30.8) 21 (72.4) 0.018
Fever episodes after tracheostomy (%) 6 (37.5) 21 (67.7) 0.047
ICU stay, days (±SD) 19.9 (7.7) 26.3 (8.3) 0.013
Hospital stay, days (±SD) 32.2 (9.6) 36.9 (7.0) 0.061
Tracheal stenosis (%) 2 (12.5) 9 (16.1) 0.287
Wound infections (%) 1 (6.3) 3 (9.7) 1.000
In-hospital mortality (%) 1 (6.3) 2 (6.5) 1.000

APACHE II: Acute Physiology and Chronic Health Evaluation II, ASIA: American Spinal Injury Association, ICU: intensive care unit, SD: standard deviation

TABLE 2.
Clinical outcome of 29 patients performed anterior cervical fusion surgery based on timing of tracheostomy
Tracheostomy p
  Early (≤7 d) Delayed (＞7 d) p
Total subjects: 29 (%) 8 (27.6) 21 (72.4)  
Age (±SD) 44.5 (13.3) 40.2 (9.8) 0.341
Male (%) 6 (75.0) 19 (90.5) 0.300
Cervical cord injury level     0.183
C1-C4 (%) 2 (25.0) 11 (52.4)  
C5-C8 (%) 6 (75.0) 10 (47.6)  
ASIA impairment scale, initial     0.232
A (%) 2 (25.0) 1 (4.8)  
B (%) 2 (25.0) 4 (19.0)  
C (%) 3 (37.5) 14 (66.7)  
D (%) 1 (12.5) 2 (9.5)  
Post-tracheostomy pneumonia (%) 2 (25.0) 17 (81.0) 0.009
Tracheostomy site infections (%) 0 1 (0.05) 1.000
Anterior cervical fusion site infections (%) 0 0 1.000
In-hospital mortality (%) 1 (12.5) 1 (4.8) 0.483

SD: standard deviation

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