Tracheostomy after cardiovascular surgery: an assessment of long-term outcome.
OBJECTIVE
To ascertain long-term survival, identify risk factors for death, and document complications of tracheostomy after cardiovascular surgery.


METHODS
Between January 1, 1998, and September 1, 2001, 188 (1.4%) of 13,191 patients undergoing cardiovascular surgery had tracheostomy for respiratory failure 5 to 79 days (median, 14 days) after surgery. Factors associated with mortality were identified in the hazard function domain, and mode of death and complications of tracheostomy were determined by follow-up.


RESULTS
Survival was 75%, 50%, and 31% at 30 days, 3 months, and 2 years, respectively. The most important risk factors for death were older age (P = .004) and variables representing deteriorating hemodynamic (P < .0001), respiratory (P < .0001), and renal (P = .0001) function between the index cardiovascular operation and tracheostomy. The mode of death was isolated respiratory failure in only 21 (16%) of 130 patients, but multisystem organ failure in 71 (55%). Follow-up of 58 survivors identified voice complaints in 13 (24%), tracheal stenosis in 5 (9.2%), and permanent tracheostomy in 3 (6%).


CONCLUSIONS
Only one third of patients undergoing tracheostomy after cardiovascular surgery survive, because it is used primarily in those with deteriorating function of multiple organ systems. Although tracheostomy may enhance patient comfort and simplify nursing care, selection algorithms need to be developed if survival is the goal of the intervention.
Walts
Peter A
PA
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Murthy
Sudish C
SC
Arroliga
Alejandro C
AC
Yared
Jean-Pierre
JP
Rajeswaran
Jeevanantham
J
Rice
Thomas W
TW
Lytle
Bruce W
BW
Blackstone
Eugene H
EH
D002318:Cardiovascular Diseases / Q000401:mortality / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology; D015999:Multivariate Analysis; D011175:Positive-Pressure Respiration; D011184:Postoperative Period; D051437:Renal Insufficiency / Q000453:epidemiology / Q000401:mortality; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014139:Tracheostomy / Q000401:mortality*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014831:Voice
D014662:Vasoconstrictor Agents