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Background: Tracheostomy is a potentially life-sustaining procedure for patients with severe stroke, yet trends in its use are not well known.Methods: Patients presenting with ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH) were identified from the 1993 to 2013 Nationwide Inpatient Sample using previously validated ICD-9-CM codes. Our outcome was tracheostomy, also defined using previously validated procedure codes. Survey weights and descriptive statistics with exact confidence intervals [CI] were used to report rates of tracheostomy, stratified by stroke type. In a secondary analysis, we used multivariate logistic regression to assess rates of tracheostomy stratified by age, race, and sex.Results: From 1993-2013, 13,729,365 patients (95% CI, 13,103,569-14,355,160) were hospitalized in the U.S. with IS, ICH, or SAH. Among these patients, 230,555 (1.7%; 95% CI, 1.6-1.8%) received a tracheostomy. The mean age of patients undergoing tracheostomy was 58.9 (±19.8) years. Rates of tracheostomy use were 1.1% (95% CI, 1.0-1.5%) after IS, 3.8% (95% CI, 3.6-4.0%) after ICH, and 6.2% (95% CI, 5.8-6.6%) after SAH. Tracheostomy was more common in men (OR, 1.32; 95% CI, 1.30-1.35), non-whites (OR, 2.04; 95% CI, 2.00-2.09), and those ≤60 years of age (OR, 2.33; 95% CI, 2.30-2.37). The overall rate of tracheostomy use after any type of stroke increased from 1.2% in 1993 to 2.0% in 2013 (p <0.001). This trend was more pronounced in patients with ICH and SAH than in patients with IS (Figure 1). Tracheostomy use increased annually by 0.9% (p <0.001) among patients ≤60 years of age versus 1.7% (p <0.001) among patients >60 years of age, and by 2.7% (p <0.001) among men versus 0.02% (p <0.05) among women.Conclusion: Over the past two decades, the use of tracheostomy appears to be increasing among patients admitted with stroke.