Early tracheostomy is associated with improved outcomes in patients who require prolonged mechanical ventilation after cardiac surgery

Jagan Devarajan, Amaresh Vydyanathan, Meng Xu, Sudish M. Murthy, Kenneth R. McCurry, Daniel I. Sessler, Joseph Sabik, C. Allen Bashour

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: The best time to perform a tracheostomy in cardiac surgery patients who require prolonged postoperative mechanical ventilation remains unknown. The primary aim of this investigation was to determine if tracheostomy performed before postoperative day 10 improves patient outcomes. Study Design: We conducted a retrospective review of prospectively collected patient information obtained from the Anesthesiology Institute Patient Registry on adult patients recovering from coronary artery bypass grafting and/or valve surgery. Demographic and comorbidity patient variables were obtained. Patients were divided into 2 groups based on the timing of their tracheostomy: early (less than 10 days) and late (14 to 28 days). The 2 patient groups were matched using propensity scores and compared on morbidity and in-hospital mortality outcomes. The primary outcomes measures were length of stay, morbidity, and in-hospital mortality. Results: After propensity matching (n = 114 patients/group), early tracheostomy was associated with decreased in-hospital mortality (21.1% vs 40.4%, p = 0.002) and cardiac morbidity (14.0% vs 33.3%, p < 0.001), along with decreased ICU (median difference 7.2 days, p < 0.001) and hospital (median difference 7.5 days, p = 0.010) durations. The occurrence of sternal wound infection (6.0% vs 19.5%, p = 0.009) was less in the early tracheostomy group, but mediastinitis did not differ significantly (3.5% vs 7.0%, p = 0.24). Conclusions: Tracheostomy within 10 postoperative days in cardiac surgery patients who require prolonged mechanical ventilation was associated with decreased length of stay, morbidity, and mortality.

Original languageEnglish (US)
JournalJournal of the American College of Surgeons
Volume214
Issue number6
DOIs
StatePublished - Jun 2012

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Tracheostomy
Artificial Respiration
Thoracic Surgery
Hospital Mortality
Morbidity
Length of Stay
Mediastinitis
Propensity Score
Anesthesiology
Wound Infection
Coronary Artery Bypass
Registries
Comorbidity
Research Design
Demography
Outcome Assessment (Health Care)
Mortality

ASJC Scopus subject areas

  • Surgery

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Early tracheostomy is associated with improved outcomes in patients who require prolonged mechanical ventilation after cardiac surgery. / Devarajan, Jagan; Vydyanathan, Amaresh; Xu, Meng; Murthy, Sudish M.; McCurry, Kenneth R.; Sessler, Daniel I.; Sabik, Joseph; Bashour, C. Allen.

In: Journal of the American College of Surgeons, Vol. 214, No. 6, 06.2012.

Research output: Contribution to journalArticle

Devarajan, Jagan ; Vydyanathan, Amaresh ; Xu, Meng ; Murthy, Sudish M. ; McCurry, Kenneth R. ; Sessler, Daniel I. ; Sabik, Joseph ; Bashour, C. Allen. / Early tracheostomy is associated with improved outcomes in patients who require prolonged mechanical ventilation after cardiac surgery. In: Journal of the American College of Surgeons. 2012 ; Vol. 214, No. 6.
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abstract = "Background: The best time to perform a tracheostomy in cardiac surgery patients who require prolonged postoperative mechanical ventilation remains unknown. The primary aim of this investigation was to determine if tracheostomy performed before postoperative day 10 improves patient outcomes. Study Design: We conducted a retrospective review of prospectively collected patient information obtained from the Anesthesiology Institute Patient Registry on adult patients recovering from coronary artery bypass grafting and/or valve surgery. Demographic and comorbidity patient variables were obtained. Patients were divided into 2 groups based on the timing of their tracheostomy: early (less than 10 days) and late (14 to 28 days). The 2 patient groups were matched using propensity scores and compared on morbidity and in-hospital mortality outcomes. The primary outcomes measures were length of stay, morbidity, and in-hospital mortality. Results: After propensity matching (n = 114 patients/group), early tracheostomy was associated with decreased in-hospital mortality (21.1{\%} vs 40.4{\%}, p = 0.002) and cardiac morbidity (14.0{\%} vs 33.3{\%}, p < 0.001), along with decreased ICU (median difference 7.2 days, p < 0.001) and hospital (median difference 7.5 days, p = 0.010) durations. The occurrence of sternal wound infection (6.0{\%} vs 19.5{\%}, p = 0.009) was less in the early tracheostomy group, but mediastinitis did not differ significantly (3.5{\%} vs 7.0{\%}, p = 0.24). Conclusions: Tracheostomy within 10 postoperative days in cardiac surgery patients who require prolonged mechanical ventilation was associated with decreased length of stay, morbidity, and mortality.",
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