From January 1, 2020, to December 1, 2021, Pubmed, Cochrane Library, Scopus, and Embase were searched to find relevant papers comparing outcomes of COVID-19 patients undergoing early and late tracheostomy. About 12 studies were chosen, including 2,222 severely sick COVID-19 patients admitted to hospitals between January and December 2020. Early and late tracheostomy were performed on 34.5% and 65.5% of the patients. Early tracheostomy was classified in 58.3% of the studies and 41.7% using cutoffs of 14 and 10 days, respectively. The early and late tracheostomy groups had similar all-cause in-hospital mortality (32.9% vs 33.1%; OR=1.00; P=0.98). Sensitivity analysis revealed that studies employing a cutoff of 10 days (34.6% vs 35.5%; OR=0.97; P=0.89) or 14 days (31.2% vs 27.7%; OR=1.05; P=0.78) had similar mortality rates. The early tracheostomy group had a shorter ICU stay (mean: 23.18 vs 30.51 days; P<0.001) and invasive mechanical ventilation (IMV) stay (mean: 20.49 vs 28.94 days; P<0.001). The duration from tracheostomy to decannulation was longer in the early tracheostomy group (mean: 23.36 vs 16.24 days; P=0.02) than in the late tracheostomy group (mean: 23.36 vs 16.24 days; P=0.02), but the time from tracheostomy to IMV weaning was comparable in both groups. Other clinical factors, such as age, were comparable across the 2 groups. When compared to late tracheostomy, early tracheostomy reduced ICU LOS and IMV time in COVID-19 patients, but both groups had identical mortality rates. The results have major implications for treating COVID-19 patients, particularly in resource-constrained settings.
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