title: Earlier versus later tracheostomy in patients with respiratory failure after cardiac surgery in the United States.
abstract: OBJECTIVE
  The objective of this study was to evaluate the impact of timing of tracheostomy on outcomes of patients with respiratory failure after cardiac surgery.
  
  
  METHODS
  Retrospective analysis of national database.
  
  
  METHODS
  United States hospitals.
  
  
  METHODS
  A weighted estimate of 2,063,227 patients (475,773 case records) undergoing cardiac surgery identified from the Nationwide Inpatient Sample between 2002-2010 INTERVENTIONS: Early versus late tracheostomy.
  
  
  RESULTS
  The incidence of postoperative respiratory failure was 7.8%. The strongest independent predictors of respiratory failure included female gender (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.28-1.31), age (OR 1.13 for each decade, 95% CI 1.12-1.13), chronic obstructive airways disease (OR 2.16, 95% CI 2.13-2.19), chronic renal insufficiency (OR 2.28, 95% CI 2.25-2.31), and valve surgery (OR 1.62, 95% CI 1.6-1.64). Tracheostomy was performed in 22.9% of patients with respiratory failure; 13.6% of tracheostomies were performed within 5 days of surgery (or within 5 days of intubation in patients who underwent reintubation), and 20.5% were performed on postoperative day 21 or later. Compared with tracheostomy performed within 5 days of intubation, there was a near-stepwise increase in risk of mortality with delayed tracheostomy performed between days 11-15 (OR 1.29, 95% CI 1.16-1.43), days 16-20 (OR 1.25, 95% CI 1.11-1.41), and day 21 or later (OR 1.53, 95% CI 1.37-1.71).
  
  
  CONCLUSIONS
  In this analysis of outcomes of patients with respiratory failure after cardiac surgery in the United States, deferring tracheostomy did not appear to improve patient outcomes after cardiac surgery.
authors.affiliation: Anesthesiology.
authors.forename: Leila
authors.initials: L
authors.lastname: Hosseinian
authors.affiliation: Cardiothoracic Surgery, The Mount Sinai Medical Center, New York, New York.
authors.forename: Yuting
authors.initials: Y
authors.lastname: Chiang
authors.affiliation: Cardiothoracic Surgery, The Mount Sinai Medical Center, New York, New York.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Itagaki
authors.affiliation: Cardiothoracic Surgery, The Mount Sinai Medical Center, New York, New York.
authors.forename: Antonio
authors.initials: A
authors.lastname: Polanco
authors.affiliation: Anesthesiology.
authors.forename: Amanda
authors.initials: A
authors.lastname: Rhee
authors.affiliation: Cardiothoracic Surgery, The Mount Sinai Medical Center, New York, New York. Electronic address: Joanna.chikwe@mountsinai.org.
authors.forename: Joanna
authors.initials: J
authors.lastname: Chikwe
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome
keywords: cardiac surgical procedures; mediastinitis; mortality; respiratory insufficiency; tracheostomy