Long-term outcomes and prognostic factors of patients undergoing tracheostomy for prolonged mechanical ventilation: A retrospective study.

چکیده اصلی

OBJECTIVE: To investigate the long-term outcomes and prognostic factors of critically ill patients undergoing tracheostomy for prolonged mechanical ventilation within the specific sociocultural and healthcare context of the Middle East. DESIGN: A retrospective observational study of patients who underwent tracheostomy between January 1, 2017, and December 31, 2020. SETTING: Medical ICU of Hamad General Hospital, a tertiary academic healthcare institution in Doha, Qatar. PATIENTS: Adult critically ill patients requiring tracheostomy for prolonged mechanical ventilation. INTERVENTIONS AND MEASUREMENTS: Tracheostomies were performed via percutaneous or open surgical techniques. Primary outcomes included neurological status (Cerebral Performance Category) and functional disability (Modified Rankin Scale) at hospital discharge. Secondary outcomes included survival rates at ICU discharge, hospital discharge, and one-year post-discharge, as well as lengths of stay. Multivariable logistic regression was utilized to identify independent prognostic factors for mortality. RESULTS: The study included 395 patients with a mean age of 55 ± 17.4 years. The percutaneous technique was more prevalent (61.3%) and accompanied by a higher proportion of good neurological outcomes; however, this likely reflects patient selection bias rather than procedural superiority. Survival rates were 82.8% at ICU discharge, 63% at hospital discharge, and 29% at one year. Multivariate analysis revealed that septic shock and higher SOFA scores were independent predictors of ICU mortality. Diverging from Western literature, age and most comorbidities were not independent predictors of long-term mortality. Instead, mortality was primarily driven by acute physiological severity (higher APACHE II and SOFA scores) and specific admission diagnoses such as ARDS and stroke. CONCLUSIONS: This study highlights a distinct epidemiological profile in the Middle East, where outcomes are driven more by acute illness severity than by age or chronic frailty. The findings underscore the unique family-anchored post-discharge care model in this region, necessitating culturally adapted strategies to manage the long-term burden of tracheostomy. IMPLICATIONS FOR CLINICAL PRACTICE: Healthcare planning in this region must account for the younger patient demographic and the heavy reliance on family caregivers. Policy reforms should focus on strengthening home-based professional support to complement family involvement and improve long-term survival.

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