Early versus late tracheostomy in stroke-related patients: A systematic review and meta-analysis

•Our study explored the safety and efficacy between early and late tracheostomy with the timeline of seven days.•Early tracheostomy exhibited shorter hospital stay, ICU stay, and ventilator days compared with late tracheostomy.•There was no statistical difference in mortality, follow-up mRS, and complication between two groups with limited sample size after trial sequential analysis. Tracheostomy is an operative intervention for patients who require ventilator assistance while in the intensive care unit (ICU). This study aimed to compare efficacy and safety between early tracheostomy (ET) and late tracheostomy (LT) in stroke patients. Embase, PubMed, and the Cochrane Library were searched for available studies. Stroke-related patients were categorized into ET and LT groups using seven days as the cutoff timepoint. The primary efficacy outcome was mortality; secondary efficacy outcomes were modified Rankin Scores (mRS) obtained at follow up, as well as durations of hospital stay, ICU stay, and ventilator use. Safety outcomes were total complication and ventilator associated pneumonia (VAP) incidence. Nine studies with 3,789 patients were included in the current analysis. No statistical difference in mortality was observed. ET was associated with shorter hospital stay (MD −5.72, 95% CI −9.76 to −1.67), shorter ICU stay (MD −4.77, 95% CI −6.82 to −2.72), and shorter ventilator duration (MD −4.65, 95% CI −8.39 to −0.90); however, no statistically significant difference was found in follow-up mRS scores. Examination of safety measures found the ET group exhibited a lower rate of VAP compared with LT (OR 0.80, 95 % CI 0.68 to 0.93), while no statistical difference was found in total complications. Our meta-analysis concluded that ET was associated with shorter hospital stay, less time on a ventilator, and lower incidence of VAP. Future studies are warranted to investigate the functional outcomes and the occurrence of complications of ET in stroke patients.