title: Early tracheostomy is associated with improved outcomes in patients who require prolonged mechanical ventilation after cardiac surgery.
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.
  
  
  METHODS
  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.
authors.affiliation: Department of General Anesthesia, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Jagan
authors.initials: J
authors.lastname: Devarajan
authors.forename: Amaresh
authors.initials: A
authors.lastname: Vydyanathan
authors.forename: Meng
authors.initials: M
authors.lastname: Xu
authors.forename: Sudish M
authors.initials: SM
authors.lastname: Murthy
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: McCurry
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.forename: Joseph
authors.initials: J
authors.lastname: Sabik
authors.forename: C Allen
authors.initials: CA
authors.lastname: Bashour
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods*; D014481:United States / Q000453:epidemiology