title: Tracheostomy after major vascular surgery.
abstract: OBJECTIVE
  Major vascular surgery such as aortic aneurysm repair may be associated with prolonged in-patient hospitalization. Certain patients undergo a tracheostomy to aid in weaning from mechanical ventilation or for secretion management. The authors hypothesized that tracheostomy after aortic reconstruction for aneurysmal disease was associated with poor outcomes.
  
  
  METHODS
  A retrospective, observational study.
  
  
  METHODS
  Vascular surgical intensive care unit (ICU) of a tertiary referral hospital.
  
  
  METHODS
  Eighty-one patients who underwent a tracheostomy after open thoracoabdominal or abdominal aortic aneurysm (AAA) repair between 1993 and 2002.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of 1,940 patients who underwent aneurysm repair, 81 (4.2%) had a tracheostomy during their index hospitalization. Of those patients, 40.7% did not survive to hospital discharge. Postoperative sepsis was associated with an increased mortality (relative risk 2.45, 95% confidence interval [CI] 1.22-4.90). Many developed postoperative renal failure and were more likely to die in the hospital (relative risk 1.53, 95% CI 1.00-2.33). The preoperative diagnosis of chronic obstructive pulmonary disease (COPD) was not associated with increased mortality (relative risk 0.471, 95% CI 0.23-0.96). Thirty-two (39.5%) patients were transferred from the ICU to a chronic ventilator dependency unit (CVDU).
  
  
  CONCLUSIONS
  Tracheostomy in patients after aortic reconstruction for aneurysmal disease is associated with a high incidence of in-hospital mortality. Patients who survive to ICU discharge are likely to be transferred to a CVDU for further respiratory management. The preoperative diagnosis of COPD is associated with improved survival, whereas postoperative sepsis is associated with an increased mortality. These observations should be considered when counseling patients and their families regarding tracheostomy after aortic surgery.
authors.affiliation: Department of Anesthesiology, Division of Critical Care, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Diedrich
authors.forename: Mark T
authors.initials: MT
authors.lastname: Keegan
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Brown
mesh_terms: D018806:APACHE; D000368:Aged; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D012121:Respiration, Artificial; D018805:Sepsis / Q000401:mortality; D013997:Time Factors; D014139:Tracheostomy