Title : When decannulation fails: Two-year outcomes of hyperacute neurorehabilitation patients discharged with a tracheostomy
Abstract:
Background/Aims: Patients requiring a tracheostomy following a neurological insult undergo structured weaning and decannulation through a multidisciplinary approach in hyperacute neurorehabilitation. Despite these efforts, some patients are discharged with a tracheostomy. We aimed to evaluate the two-year outcomes of patients admitted with a tracheostomy, with particular emphasis on those discharged without successful decannulation and the influence of lesion location.
Methods: A retrospective review was undertaken of all patients admitted to a Hyperacute Rehabilitation Unit (HARU) with a tracheostomy between 2022 and 2024. Electronic patient records were reviewed to collect demographic data, neurological pathology, tracheostomy and decannulation outcomes, discharge status, and mortality up to two years following discharge.
Results: Seventy-two patients were admitted to HARU with a tracheostomy during the study period. Overall, the decannulation success rate was 69.4% (50/72). Twenty-two patients (30.6%) were discharged with a tracheostomy. At two-year follow-up, 14/22 (63.6%) remained alive, while 8/22 (36.4%) had died. Of total cohort, 12/72 (16.7%) had neurological injuries involving the infratentorial compartment. This subgroup had markedly poorer outcomes: 7/12 (58.3%) died, 3/12 (25.0%) remained alive with a tracheostomy at two years, and only 2/12 (16.7%) achieved successful decannulation. In comparison, patients with supratentorial pathology had substantially higher decannulation rates (38/60, 63.3%) and lower mortality (11/60, 18.3%). Utilising the Fisher exact test, the difference in mortality (p=0.003) and decannulation (p=0.006) was significant between these two subgroups.
Conclusion: Most patients admitted to HARU with a tracheostomy achieved successful decannulation through a multidisciplinary rehabilitation approach. However, patients who remained tracheostomy dependent at discharge represented a high-risk group, with a two-year mortality rate of 36.4%. In subgroups, the supratentorial were noted to have statistically significant higher decannulation rate and lower mortality as compared to the infratentorial. These findings highlight the importance of early prognostic discussions for patients discharged with a tracheostomy following their neurological injury. Although this represents a relatively large single-centre HARU cohort, larger multicentre studies are needed to confirm these findings and improve the precision of long-term outcome estimates.
