Abstract
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.