Beyond Early vs. Late: A Bayesian Evaluation of Tracheostomy Timing and Outcomes in Critical Illness

BACKGROUND: The ideal timing of tracheostomy in critically ill patients remains controversial. Although early procedures may yield better outcomes, the specific contributions of each decision-making interval remain poorly defined. Here, we aimed to evaluate the associations of overall tracheostomy timing and component intervals with ventilator weaning, intensive care unit (ICU) discharge, mortality, and hospital costs. METHODS: In this retrospective cohort study, we included 480 patients admitted to the ICU who underwent tracheostomy between 2021 and 2023 at a single center. Patients were classified by tracheostomy timing into early (< 7 days), standard (7-14 days), and late (> 14 days) groups. Timing was also evaluated as a continuous variable and divided into 3 clinical intervals: from intubation to suggestion, suggestion to consultation, and consultation to the procedure. Ventilator weaning and ICU discharge were modeled using a Bayesian competing-risk survival approach. Mortality and medical expenditures were assessed using Bayesian logistic regression and Bayesian Gaussian regression, respectively. Propensity score matching was applied in the sensitivity analyses. RESULTS: Late tracheostomy was associated with lower probabilities of ventilator weaning and ICU discharge and with higher medical costs. Early tracheostomy was associated with the most favorable outcomes. Delays in the interval between intubation and tracheostomy were consistently associated with poor weaning outcomes. Mortality associations were less certain but suggested a potentially unfavorable pattern with delayed procedures. These findings remained consistent after matching. CONCLUSIONS: Among patients who ultimately underwent tracheostomy, timing < 7 days was associated with the most favorable observed outcomes, whereas the 7-14-day group generally showed intermediate results. These associations should not be interpreted as evidence that an early-tracheostomy strategy is optimal for all patients.