Tracheostomy and Gastrostomy After Decompressive Craniectomy: What Surrogates Need to Know

Abstract

Background: Many patients require tracheostomy or feeding gastrostomy for airway stability and proper nutrition after decompressive craniectomy (DC) for trauma or stroke. Tracheostomy and/or gastrostomy implementation may impact decisions for end-of-life care. The authors hypothesized that patients surviving DC were more likely to have received a tracheostomy and/or gastrostomy than those who did not survive. Furthermore, the authors hypothesized that patients who did not receive a tracheostomy and/or gastrostomy were more likely to proceed to withdrawal of life-preserving care as the alternative.

Methods: Data collected from DC patients from 2014 to 2022 included age, admission setting, diagnosis (stroke, trauma), admission Glasgow Coma Scale (GCS), preoperative GCS, time to decompression after presentation, and socioeconomic factors. Patients with tracheostomy and/or gastrostomy were compared to patients not receiving tracheostomy or gastrostomy for the above characteristics and their outcomes (discharge disposition, Glasgow Outcome Scale (GOS), modified Rankin Scale (mRS), status of inpatient hospice/palliative care, and cause of death). Statistical tests used for analysis included Chi-square, two-sided t-test, and multiple logistic regression models (significance < 0.05).

Results: Sixty-six patients were included. More patients without tracheostomy and/or gastrostomy (32 patients) died than patients who received tracheostomy and/or gastrostomy (34 patients) (P = 0.0394). GOS and mRS did not differ between patients with tracheostomy and/or gastrostomy and patients without tracheostomy or gastrostomy (P = 0.1331 and 0.5421, respectively). Patients without tracheostomy or gastrostomy were more likely to have been placed on general inpatient hospice (GIP) (P = 0.0183) or had comfort care initiated (P = 0.00913).

Conclusions: Patients who survive after DC are more likely to have received tracheostomy and/or gastrostomy than those who did not survive. Patients who seek end-of-life care, including withdrawal of care and GIP, are more likely to not receive tracheostomy or gastrostomy.

J Neurol Res. 2024;14(2):59-67
doi: https://doi.org/10.14740/jnr779