Hospitalization and Survival Following Early vs. Late Percutaneous Tracheostomy Under Bronchoscopic Guidance: Analysis of 207 Cases

Background: Tracheostomy is a commonly performed procedure for patients requiring prolonged mechanical ventilation. It can be performed at the bedside using percutaneous dilatational tracheostomy (PDT) under bronchoscopic guidance (BG), which reduces the need for surgical tracheostomies. The aim of this study was to compare early versus late PDT in terms of complications and survival. Methods: This retrospective study included patients who underwent BG-PDT between 2012 and 2022 at the Pulmonary Institute of Rabin Medical Center. Data were collected by reviewing demographic and clinical parameters from electronic medical records, with a minimum follow-up of 24 months after the BG-PDT procedure. Early BG-PDT was defined as a procedure performed within 7 days of intubation and late PDT was performed from day 8 and onward. Results: A total of 207 BG- PDT procedures were performed between 2012 and 2022, of which 188 patients were included in the final analysis. The mean age of the patients was 69 years, with 57.5% being male. Patients who underwent early BG-PDT were younger (mean age 63 vs. 71, p < 0.01).The most common indications for PDT were respiratory disorders (47.8%) and neurological disorders (19.1%). Patients who underwent early PDT had shorter hospitalization (17.4 vs. 39.7 days, p < 0.01), and a higher one-year (54.3% vs. 30%, p = 0.04) and 3 year survival rate of 45.4% in the early vs 19.6% in the latep = 0.008. Conclusions: Percutaneous dilation tracheostomy under bronchoscopc guidance is associated with shorter hospitalization duration and has survival advantages when performed within 7 days of intubation.