title: Tracheostomy after cardiac operations: in-hospital and long-term survival.
abstract: BACKGROUND
  Patients with ventilator dependency after cardiac operations may require a tracheostomy. This study determined the hospital and postdischarge outcome in a series of patients who underwent a tracheostomy due to ventilator dependency after cardiac operations.
  
  
  METHODS
  Medical records of cardiac surgical patients were retrospectively reviewed for preoperative, intraoperative, and postoperative variables, and also prospective follow-up for all-cause mortality. All adult patients treated with tracheostomy due to postoperative ventilator dependency between January 1, 2004, and December 31, 2009, were admitted to the study. Statistical methods included a multivariable logistic regression analysis for hospital mortality and a Kaplan-Meier analysis with multivariable Cox regression model for postdischarge mortality.
  
  
  RESULTS
  The study group included 131 patients. The hospital mortality rate was 49%. The only independent predictor for hospital mortality was the number of fresh frozen plasma units transfused during the hospital stay (6% mortality risk increase per each unit transfused). Survival rate for patients discharged from the hospital was 61% at 1 year, 49% at 2 years, 45% at 3 years, and 34% at 5 years. Factors affecting death after discharge were concomitant postoperative heart failure (hazard ratio, 2.6) and the length of ventilator dependency.
  
  
  CONCLUSIONS
  Patients with a respiratory failure without associated heart failure or neurologic dysfunction have a significantly better long-term outcome. Caution should be applied in the use of fresh frozen plasma in patients with postoperative respiratory failure and ventilator dependency requiring a tracheostomy.
authors.affiliation: Department of Cardiothoracic-Vascular Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ballotta
authors.forename: Hassan
authors.initials: H
authors.lastname: Kandil
authors.forename: Tommaso
authors.initials: T
authors.lastname: Generali
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Menicanti
authors.forename: Gabriele
authors.initials: G
authors.lastname: Pelissero
authors.forename: Marco
authors.initials: M
authors.lastname: Ranucci
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D006333:Heart Failure / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010949:Plasma; D011183:Postoperative Complications / Q000401:mortality* / Q000628:therapy; D016016:Proportional Hazards Models; D012131:Respiratory Insufficiency / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D014139:Tracheostomy / Q000401:mortality*; D015300:Ventilator Weaning