P36 Characteristics and outcomes of spinal cord injury patients discharged from a tertiary spinal injuries unit with long-term tracheostomy ventilation

BackgroundPatients sustaining a Spinal Cord Injury (SCI) may require long-term mechanical ventilation via a tracheostomy. Little UK data exists regarding outcomes of such patients following hospital discharge. We aimed to define the characteristics and chart the outcomes of adult SCI patients discharged with tracheostomy ventilation from a tertiary spinal injuries unit.MethodologyThe records of patients discharged with long-term tracheostomy ventilation from the Northwest Regional Spinal Injuries Centre were retrospectively analyzed with comorbidity defined using ICD-10 coding.ResultsThe records of 47 patients (Age 51 years (Range 66 years), LOS 366 days (Range 1738 days), 72% male) with SCI discharged with long-term tracheostomy ventilation between1982 and 2019 were available for analysis. 83% (39/47) were classified as sustaining a Traumatic SCI with the level of injury on discharge being C0–1 in 15%, C2–4 in 62% and C5–6 in 15%. 68% (32/47) and 17% (8/47) were classified as ASIA-A and ASIA-B respectively on discharge. 68% (32/47) were exclusively on a normal diet/fluids whilst 23% (11/47) were exclusively fed by a gastrostomy tube. 53% (25/47) were discharged on 24 hour ventilation whilst 47% (22/47) were discharged on a minimum of nocturnal ventilation but less than 24 hour ventilation. 72% (34/47) were discharged to their own place of residence whilst 28% (13/47) were discharged to Institutional Care. 9% (4/47) of subjects had died 12 months post hospital discharge increasing to 17% (8/47) who had died at 3 years post hospital discharge and 21% (10/47) who had died by 5 years post discharge. A coded diagnosis of underlying Pulmonary Disease was associated with death at 12 months (p=0.04) but did not appear to be a significant adverse prognostic factor by 3 or 5 years post discharge. Advanced age was associated with death at 5 years (64 (11) years v 41 (20) years). The level of injury, ASIA classification, length of stay and degree of ventilator dependence did not appear to be linked to survival.ConclusionPatients diagnosed as SCI with long-term tracheostomy ventilation have favourable outcomes following hospital discharge. A coded diagnosis of pulmonary disease predicts early mortality in this group.