Stroke is a major cause of disability, with previously published studies demonstrating that 12% of stroke patients are mechanically ventilated with 16% of these subsequently undergo tracheostomy. Readmission rates in mechanically ventilated patients are a marker of morbidity and health care cost, which has been evaluated in medically and surgically ill patients, but not previously in stroke patients; here, the authors looked at readmission rates for patients who received mechanical ventilation, stratified by whether tracheostomy was performed.

One-quarter of stroke patients who underwent mechanical ventilation underwent placement of a tracheostomy prior to discharge; a small minority of those who were discharged without a tracheostomy did ultimately go on to receive a tracheostomy on a subsequent readmission. Even after adjusting for stroke type, comorbidities, vascular risk factors, and demographic characteristics, 30-day readmission rates were found to be higher in patients who underwent tracheostomy compared to those who did not, with sepsis being the most common diagnosis at time of readmission, followed by pneumonia, congestive heart failure and device related complication.

What does this mean for clinicians? Although tracheostomy does seem to be associated with higher readmission rates in stroke patents, the readmission rate is similar to that seen in patients hospitalized for medical illnesses such as pneumonia and that seen in general intensive care unit patients. One interpretation of the data, which the authors opined, is that tracheostomy placement in a stroke patient does not necessarily imply drastically worse outcomes, given that the readmission rate is similar in other medically ill populations. Some confounding factors, such as differences in stroke severity, was not available to the authors for analysis, which could potentially impact which patients require tracheostomy and be a similar independent factor in which patients require readmission. Results from this study therefore do not provide definitive guidance on how to necessarily counsel patients and their families on the long-term outcomes of mechanical ventilation and tracheostomy in stroke patients, but may help clinicians place the consequences of tracheostomy in this specific population into a larger context and perspective.