Muneyoshi Tagami1, Fumiharu Kimura2, Hideto Nakajima3, Shimon Ishida4, Shinya Fujiwara5, Yoshimitsu Doi6, Takafumi Hosokawa7, Kazushi Yamane8, Kiichi Unoda9, Takahiko Hirose10, Hiroki Tani11, Shin Ota12, Takumi Ito13, Masakazu Sugino14, Keiichi Shinoda15, Toshiaki Hanafusa16. 1. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: mu.tagami0728@gmail.com. 2. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1110@poh.osaka-med.ac.jp. 3. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1045@poh.osaka-med.ac.jp. 4. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1212@poh.osaka-med.ac.jp. 5. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1291@poh.osaka-med.ac.jp. 6. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1311@poh.osaka-med.ac.jp. 7. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1237@poh.osaka-med.ac.jp. 8. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1303@poh.osaka-med.ac.jp. 9. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1287@poh.osaka-med.ac.jp. 10. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1371@poh.osaka-med.ac.jp. 11. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1372@poh.osaka-med.ac.jp. 12. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1385@poh.osaka-med.ac.jp. 13. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1017@poh.osaka-med.ac.jp. 14. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1052@poh.osaka-med.ac.jp. 15. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: in1027@poh.osaka-med.ac.jp. 16. Division of Neurology, Department of Internal Medicine (I), Osaka Medical College, Japan. Electronic address: hanafusa@poh.osaka-med.ac.jp.
Abstract
OBJECTIVE: To evaluate the factors related to the choice of a tracheostomy and invasive ventilation in amyotrophic lateral sclerosis patients and to determine survival time after a tracheostomy at a single institute in Japan between 1990 and 2010. METHODS: Data for survival time until death or tracheostomy were obtained from 160 patients. Fifty-two patients (33%) underwent tracheostomy/mechanical ventilation. RESULTS: Tracheostomy and invasive ventilation prolonged median survival time (74 months), as did non-invasive ventilation (48 months) when compared to a non-ventilation-supported control group (32 months; p<0.001 each). The ratio of tracheostomy/mechanical ventilation in patients >65 years old significantly increased after 1999 (27%) compared to earlier years (10%, p=0.002). Cox proportional modeling confirmed an age of ≤65 years as advantageous for long-term survival after a tracheostomy. In univariate logistic regression analysis, factors related to the decision to perform a tracheostomy included an age of ≤65 years, greater use of non-invasive ventilation, the presence of a spouse, interval and speed from disease onset to diagnosis/tracheostomy and preservation of motor function. In multivariate logistic regression analysis, age, shorter duration from disease onset until tracheostomy and the presence of a spouse were independently associated with the decision to perform a tracheostomy. Kaplan-Meier plots revealed longer survival times in patients who resided at home after a tracheostomy compared to patients who stayed at a hospital (p=0.007). CONCLUSIONS: Tracheostomy and invasive ventilation are frequently used in Japan. Various factors impact patients' decisions to have these procedures. This study identified factors related to the decision-making process and post-tracheostomy survival.
OBJECTIVE: To evaluate the factors related to the choice of a tracheostomy and invasive ventilation in amyotrophic lateral sclerosispatients and to determine survival time after a tracheostomy at a single institute in Japan between 1990 and 2010. METHODS: Data for survival time until death or tracheostomy were obtained from 160 patients. Fifty-two patients (33%) underwent tracheostomy/mechanical ventilation. RESULTS: Tracheostomy and invasive ventilation prolonged median survival time (74 months), as did non-invasive ventilation (48 months) when compared to a non-ventilation-supported control group (32 months; p<0.001 each). The ratio of tracheostomy/mechanical ventilation in patients >65 years old significantly increased after 1999 (27%) compared to earlier years (10%, p=0.002). Cox proportional modeling confirmed an age of ≤65 years as advantageous for long-term survival after a tracheostomy. In univariate logistic regression analysis, factors related to the decision to perform a tracheostomy included an age of ≤65 years, greater use of non-invasive ventilation, the presence of a spouse, interval and speed from disease onset to diagnosis/tracheostomy and preservation of motor function. In multivariate logistic regression analysis, age, shorter duration from disease onset until tracheostomy and the presence of a spouse were independently associated with the decision to perform a tracheostomy. Kaplan-Meier plots revealed longer survival times in patients who resided at home after a tracheostomy compared to patients who stayed at a hospital (p=0.007). CONCLUSIONS: Tracheostomy and invasive ventilation are frequently used in Japan. Various factors impact patients' decisions to have these procedures. This study identified factors related to the decision-making process and post-tracheostomy survival.
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