Tracheostomy and mortality in patients with severe burns: A nationwide observational study
Tracheostomy and mortality in patients with severe burns: A nationwide observational study
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DOI：
10.1016/j.burns.2018.06.012
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发表时间：
2018-12-01
期刊：
影响因子：
2.7
通讯作者：
Yasunaga, Hideo
中科院分区：
文献类型：
--
作者：
Tsuchiya, Asuka;Yamana, Hayato;Yasunaga, Hideo
背景：气管切开术通常对接受长时间机械通气的严重烧伤患者进行。然而，气管切开术的适当时机及其对死亡率的影响仍然未知。本研究的目的是确定气管切开术是否可以降低严重烧伤患者的死亡率。方法：利用2010年4月至2014年3月的日本诊断程序组合数据库，提取入院3天内开始机械通气的成年严重烧伤患者（烧伤指数≥15）的数据。我们估计了与气管切开术相关的 28 天院内死亡率的风险比，从天到 28 天。我们使用治疗加权方法的逆概率对基线和时间依赖性混杂因素进行了调整，并拟合了边际结构性 Cox 比例风险模型。结果：我们确定了 680 名符合条件的患者（气管切开术组 94 例，2289 人日；非气管切开术组 586 例，11,197 人日）人日）。接受气管切开术的患者的死亡率预后因素更差。调整这些因素后，与非气管切开术相关的 28 天死亡率的风险比为 0.73（95% 置信区间，0.39-1.34）。结论：严重烧伤成人患者的 28 天院内死亡率与早期气管切开术之间没有显着相关性。 (C) 2018 Elsevier Ltd 和 ISBI。版权所有。
Background: Tracheostomy is often performed in patients with severe burns who are undergoing prolonged mechanical ventilation. However, the appropriate timing of tracheostomy and its effect on mortality remain unknown. The aim of this study was to determine whether tracheostomy can reduce mortality in patients with severe burns.Methods: Using the Japanese Diagnosis Procedure Combination database from April 2010 to March 2014, we extracted data on adult patients with severe burns (burn index score of >= 15) who started mechanical ventilation within 3days of admission. We estimated the hazard ratio for 28-day in-hospital mortality associated with tracheotomy performed from days to 28. We adjusted for baseline and time-dependent confounders using inverse probability of treatment weighting methods and fitted a marginal structural Cox proportional hazard model.Results: We identified 680 eligible patients (94 in the tracheostomy group, 2289 person-days; 586 in the non-tracheostomy group, 11,197 person-days). Patients who underwent a tracheostomy had worse prognostic factors for mortality. After adjustment for these factors, the hazard ratio for 28-day mortality associated with tracheostomy compared with non-tracheostomy was 0.73 (95% confidence interval, 0.39-1.34).Conclusions: There was no significant association between 28-day in-hospital mortality and early tracheostomy in adult patients with severe burns. (C) 2018 Elsevier Ltd and ISBI. All rights reserved.