Long-Term Implications of Tracheostomy in Cardiac Surgery Patients: Decannulation and Mortality.
Ann Thorac Surg. 2020 Jun 30;:
Authors: Krebs ED, Chancellor WZ, Beller JP, Mehaffey JH, Hawkins RB, Sawyer RG, Yarboro LT, Ailawadi G, Teman NR
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
PMID: 32619618 [PubMed - as supplied by publisher]