Impact of tracheostomy timing on postoperative outcomes following anterior cervical discectomy and fusion for sub-axial cervical fractures: A retrospective analysis.

Aims & objectives: To evaluate the association between tracheostomy timing after anterior cervical discectomy and fusion (ACDF) for sub-axial cervical spine injuries and 90-day postoperative complications. Materials & methods: A retrospective cohort study was conducted. Patients aged 18-84 years who had fractures of the sub-axial cervical spine and underwent ACDF were identified using CPT and ICD codes from the PearlDiver database (2010-2022Q2) and stratified into early (0-5 days), intermediate (6-10 days), and late (11-20 days) tracheostomy groups post-ACDF. Exclusion criteria included prior cervical spine infection, malignancy, and posterior surgical approaches. Baseline comorbidities and surgical characteristics were assessed. 90-day primary and secondary outcomes were assessed with multivariable logistic regression. Results: Among 594 patients, baseline differences were noted: the late group had higher rates of COPD (15.3 %), CHF (15.3 %), and pre-tracheostomy ventilator use (52.3 %) (all p < 0.05). Vertebral artery dissection was most common in the early group (17.0 %, p = 0.017). Intermediate tracheostomy was associated with a lower pneumonia rate vs. early (OR 0.59, 95 % CI: 0.38-0.93; p = 0.022). Late tracheostomy was associated with a lower cerebrovascular accident (CVA) rate vs. early (OR 0.05, 95 % CI: 0.00-0.40; p = 0.014). No significant differences were observed in wound infections, other complications, or ventilator dependence at discharge. Conclusion: Early tracheostomy after ACDF was not associated with increased surgical site infection, supporting its safety. However, the early group had a higher incidence of vertebral artery dissection pre-tracheostomy and was linked to higher 90-day pneumonia and CVA rates compared to intermediate and late groups, respectively.