Risk Factors for Tracheostomy in Traumatic Spinal Cord Injury Patients: A Level 1 Trauma Center Study and Performance Analysis

Risk factors and timing of tracheostomy for spinal cord injury (SCI) have been identified. However, how these factors are incorporated into clinical decision-making remains unclear. This study aimed to identify the factors associated with tracheostomy placement across the spinal cord and evaluate tracheostomy in high-risk patients with SCI. Patients with traumatic SCI were evaluated between January 2016 and December 2024, using univariate and multivariate logistic regression analyses. Tracheostomy timing was compared with recommendations of ≤10 days for high-risk patients with SCI. High-risk patients were those with complete SCI, injury ≤C7, injury severity score (ISS) >16, age ≥45 years, smoking history, or chronic respiratory disease. Among 674 included patients, 46 underwent tracheostomy. Diabetes (odds ratios (ORs) 3.12, 95% CI: 1.50-6.49; P =0.002), COPD (OR: 3.60, 95% CI: 1.46-8.88; P = 0.005), increasing ISS (OR: 1.22, 95% CI: 1.09-1.36; P < 0.001), primary injuries involving C5-C7 (OR: 12.36, 95% CI: 1.36-112.36; P = 0.026), and complete SCI (OR: 9.86, 95% CI: 3.03-32.08; P < 0.001) were associated with tracheostomy placement. In total, 29/46 (63%) tracheostomies occurred after 10 days, with no difference in complication rates (70.6% vs 72.4%). Cervical stabilization did not delay the tracheostomy. Posterior stabilization showed the shortest time (9.0 ± 2.9 vs 11.4 ± 5.9 days). Most high-risk patients with SCI underwent tracheostomy beyond the recommended 10-day window, highlighting challenges in translating guideline recommendations into practice. This suggests that recognized risk factors may serve as triggers for early tracheostomy.