title: Tracheostomy: a risk factor for mediastinitis after cardiac operation.
abstract: BACKGROUND
  We studied whether tracheostomy after coronary artery bypass grafting (CABG) is associated with higher incidence of mediastinitis and mortality, and whether shorter intervals between median sternotomy and tracheotomy are associated with higher incidence of mediastinitis.
  
  
  METHODS
  Patients (n = 6,057) undergoing CABG since March 1977 were reviewed. Patients requiring tracheostomy and those developing mediastinitis were identified. Mediastinitis diagnosis required positive culture of mediastinal tissue or fluid.
  
  
  RESULTS
  After CABG, 88 patients had tracheostomy performed (1.45%). Seven patients receiving tracheostomy after developing mediastinitis were excluded. Of the remaining 81 patients, 7 developed mediastinitis (8.6%) compared with 44 of 5,969 (0.7%) who did not require tracheostomy (p < 0.001). Mortality in tracheostomy patients was 24.7% (20 of 81) compared with 5.2% in patients not requiring tracheostomy (316 of 5,969; p < 0.001). Patients not developing mediastinitis had tracheostomy placement an average of 25 days after CABG compared with 18.7 days for those developing mediastinitis (p = 0.141).
  
  
  CONCLUSIONS
  Tracheostomy after CABG is associated with increased incidence of mediastinitis and mortality. In this review, the time interval between CABG and tracheostomy was not predictive of mediastinitis. A larger sample size would be required to be confident that there is no correlation.
authors.affiliation: Department of Cardiothoracic Surgery, University of Missouri, Columbia, USA. curtisj@health.missouri.edu
authors.forename: J J
authors.initials: JJ
authors.lastname: Curtis
authors.forename: N C
authors.initials: NC
authors.lastname: Clark
authors.forename: C A
authors.initials: CA
authors.lastname: McKenney
authors.forename: J T
authors.initials: JT
authors.lastname: Walls
authors.forename: R A
authors.initials: RA
authors.lastname: Schmaltz
authors.forename: T L
authors.initials: TL
authors.lastname: Demmy
authors.forename: J W
authors.initials: JW
authors.lastname: Jones
authors.forename: W R
authors.initials: WR
authors.lastname: Wilson
authors.forename: C C
authors.initials: CC
authors.lastname: Wagner-Mann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000209:etiology* / Q000401:mortality; D008875:Middle Aged; D011182:Postoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D013249:Sternum / Q000601:surgery; D013530:Surgical Wound Infection / Q000209:etiology*; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects* / Q000401:mortality