The long-term implications of tracheostomy in cardiac surgical patients are largely unknown. We sought to investigate outcomes including decannulation and long-term mortality in a population of post-cardiac surgery patients.
All patients undergoing cardiac surgery at a single institution between 1997-2016 were evaluated for postoperative tracheostomy placement, time to decannulation and mortality. Patients were stratified by tracheostomy placement, as well as successful decannulation for comparison. Kaplan-Meier analysis identified time to decannulation and mortality and a Fine-Gray’s competing risk regression, accounting for mortality, identified predictors of time to decannulation.
Of 14,600 total cardiac surgery patients, only 309 required tracheostomy. Patients with tracheostomy had high rates of perioperative comorbidities, including 60% with heart failure and 24% with postoperative stroke. Tracheostomy patients had high short and long-term mortality, with a median survival of 152 days, 1-year survival of 41%, and 5-year survival of 29.1%. Patients remained with tracheostomy in place for a median of 59 days, with a 1-year decannulation rate of 80% in living patients. Those with older age (HR 0.98, p=0.01), chronic lung disease (HR 0.66, 0.03) and preoperative or postoperative dialysis (HR 0.45, p<0.01) were less likely to have their tracheostomy removed.
Tracheostomy is associated with poor long-term survival in cardiac surgery patients. However, those who do survive have a short duration of tracheostomy with almost all surviving patients eventually decannulated. This provides valuable information for pre-procedural counseling for these high-risk patients and their families.
Copyright © 2020. Published by Elsevier Inc.