BACKGROUND The optimal timing for tracheostomy among patients with acute heart failure (AHF) exacerbation has been controversial, despite multiple studies assessing the utility of early tracheostomy. Our objective was to assess the trend of utilization and outcomes of early tracheostomy among patients with AHF exacerbation in the United States. METHODS AND RESULTS A retrospective cohort study using the National Inpatient Sample from 2005 to 2014 was conducted. Among those who were admitted with AHF exacerbation (n = 1,390,356), 0.26% of patients underwent tracheostomy (n = 2,571), and among them, 19.4% received early tracheostomy (n = 496). There was no significant shift in the percentage of early tracheostomy from 2008 to 2014. We used propensity score matching to compare the clinical and economic outcomes between the early tracheostomy group and late tracheostomy group. In-hospital mortality did not show any difference between the two groups (13.97% in early group vs. 18.04% in late group; p =0.163). The median total hospital cost ($53,466), total hospital length of stay (19 days), and length of stay after intubation (16 days) in the early tracheostomy group were significantly lower than in the late tracheostomy group ($73,680; 26 days; 23 days, respectively). CONCLUSION Early tracheostomy showed economic benefit with lower hospital costs and shorter length of stay, without a difference in in-hospital mortality compared to late tracheostomy.

中文翻译：

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急性心力衰竭加重的早期气管切开术

背景 尽管多项研究评估了早期气管切开术的实用性，但对于急性心力衰竭 (AHF) 恶化患者进行气管切开术的最佳时机一直存在争议。我们的目标是评估美国 AHF 急性加重患者早期气管切开术的使用趋势和结果。方法和结果 使用 2005 年至 2014 年的全国住院患者样本进行了一项回顾性队列研究。在因 AHF 恶化入院的患者中（n = 1,390,356），0.26% 的患者接受了气管切开术（n = 2,571），其中 19.4% 接受了早期气管切开术（n = 496）。从 2008 年到 2014 年，早期气管切开术的百分比没有显着变化。我们使用倾向评分匹配来比较早期气管造口组和晚期气管造口组之间的临床和经济结果。两组之间的院内死亡率没有任何差异（早期组 13.97% 与晚期组 18.04%；p = 0.163）。早期气管造口组的中位总住院费用（53,466 美元）、总住院时间（19 天）和插管后住院时间（16 天）显着低于晚期气管造口组（73,680 美元；26 天；23天，分别）。结论 早期气管切开术与晚期气管切开术相比，具有更低的住院费用和更短的住院时间，并且在院内死亡率方面没有差异。晚组 04%；p = 0.163）。早期气管造口组的中位总住院费用（53,466 美元）、总住院时间（19 天）和插管后住院时间（16 天）显着低于晚期气管造口组（73,680 美元；26 天；23天，分别）。结论 早期气管切开术与晚期气管切开术相比，具有更低的住院费用和更短的住院时间，并且在院内死亡率方面没有差异。晚组 04%；p = 0.163）。早期气管造口组的中位总住院费用（53,466 美元）、总住院时间（19 天）和插管后住院时间（16 天）显着低于晚期气管造口组（73,680 美元；26 天；23天，分别）。结论 早期气管切开术与晚期气管切开术相比，具有更低的住院费用和更短的住院时间，并且在院内死亡率方面没有差异。