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Objectives: Early tracheostomy (fewer than eight days after intubation) is associated with shorter length of stay in the intensive care unit and shorter duration of mechanical ventilation. Studies assessing the association between early tracheostomy and incidence of delirium, however, are lacking. This investigation sought to fill this gap., Design: Retrospective cross-sectional study., Setting: Multi-institutional acute care facilities in the United States., Participants: Data were derived from the National Inpatient Sample data from 2010 to 2014. Included patients were 65 or older and underwent both intubation and tracheostomy during the hospitalization. The authors excluded patients who underwent multiple intubations or tracheostomy procedures., Interventions: Early tracheostomy versus non-early tracheostomy., Results: In total, 23,310 patients were included, of whom 24.8% underwent early tracheostomy. From multivariate logistic regression, early tracheostomy was associated with lower odds of having a delirium diagnosis (odds ratio [OR] 0.77, p < 0.00001) across all admission classifications. Upon subgroup analysis, early tracheostomy was associated significantly with lower odds of having delirium for patients admitted with medical (OR 0.74, p < 0.00001) and nonsurgical injury admissions (OR 0.74, p = 0.00116)., Conclusions: Early tracheostomy was associated significantly with lower odds of delirium among all patients studied. This association held true across medical and nonsurgical subgroups., Competing Interests: Conflict of Interest None., (Published by Elsevier Inc.)

Background: Yearly rate and mean patient age of left ventricular assist device (LVAD) implantation increased from 2009 to 2014. Data are lacking regarding trends of LVAD implantation in older adults., Objectives: To describe the trends of LVAD implantation in older adults and the clinical impact of associated procedural complications., Methods: We retrospectively analyzed the National Inpatient Sample from 2005 to 2014, calculated the percentage of older adults (>65 years of age) among those who underwent LVAD implantation, and compared their clinical characteristics. Primary outcomes were in-hospital mortality and discharge home., Results: In total, 4491 patients were included. The percentage of older adults among those receiving LVAD increased from 12.53% to 31.65% (p<0.01). Older adults were more likely to develop postoperative delirium (17.90% vs. 11.92% in younger patients; p<0.01), which portended lesser odds of discharge home., Conclusions: Delirium develops with greater incidence in older adults undergoing LVAD implantation, which decreases odds of favorable discharge disposition., Competing Interests: Declaration of Competing Interest BA, SK, SN, IAS, BK, and IDG all report receiving in-kind support from medical companies for travel and lodging, food and beverage, and education. All transactions are reported on the OpenPayments website in accordance with the Sunshine Act, and none rise to the level of a conflict of interest., (Copyright © 2020 Elsevier Inc. All rights reserved.)