Tracheostomy after Cardiac Surgery: A 17-years single center experience

Background and aim of the study: A regular post-cardiac surgery course does not require a prolonged stay in the cardiac surgery intensive care unit (ICU). However, a complicated postoperative period, can lead to prolonged ICU stay and prolonged ventilation, and may require a tracheostomy. Nonetheless, there is currently no consensus regarding the proper timing of tracheostomy. Data regarding long-term outcomes of early versus late tracheostomy are limited. This study represents the largest single-center experience with post-cardiac surgery tracheostomy. The aim of this study was to assess the timing of tracheostomy as a risk factor for mortality. Methods: This is a retrospective study of prospectively collected data. Patients were divided into three groups according to the timing of tracheostomy; early (4-10 days); intermediate (11-20 days) and late (≤21 days). The primary outcomes were early, intermediate, and long-term mortality. For statistical analysis we use multivariable Cox proportional hazards model. Results: Between 09.2004 and 08.2021, 12,782 patients underwent cardiac surgery at our institution, of whom 407 (3.18%) required postoperative tracheostomy. 147 (36.1%) had early, 195 (47.9%) intermediate and 65 (16%) late tracheostomy. The three groups were similar regarding their baseline characteristics and operative data. Early, 30-day and in-hospital mortality was similar for all groups. However, patients, who underwent early- and intermediate tracheostomy, demonstrating statistically significant lower mortality after 1- and 5-year (42.8%; 57.4%; 64.6%; and 55.8%; 68.7%; 75.4%, respectively; p<0.001). In our patient’s cohort Cox model show age [1.025 (1.014-1.036)] and time to tracheostomy [0.315 (0.159-0.757)] as significant factor for mortality. Conclusions: This study demonstrates a relationship between the timing of tracheostomy after cardiac surgery and mortality: early tracheostomy within 4-10 days of mechanical ventilation associated with better intermediate- and long-term survival. Short-term mortality does not seem to be affected by the timing of tracheostomy. Optimal timing of tracheostomy requires further evaluation.