Tracheostomy After Cardiac Surgery: Timing of Tracheostomy as a Risk Factor for Mortality

ObjectivesThe optimal timing for tracheostomy after cardiac surgery in patients undergoing prolonged ventilation is controversial. The aim of this study was to assess the effect of tracheostomy timing on short- and long-term mortality of these patients.DesignRetrospective study of prospectively collected data.SettingCardiac surgical intensive care unit (ICU) in a tertiary-care, university-affiliated hospital.ParticipantsAll patients undergoing tracheostomy after cardiac surgery between September 2004 and March 2013 were included.InterventionsThe authors compared the outcome in 2 groups of patients according to the timing of tracheostomy: Group I, early-intermediate tracheostomy (0-14 days) and Group II, late tracheostomy (≥15 days).Measurements and Main ResultsDuring the study period, 6,069 patients underwent cardiac surgery; among them, 199 patients (3.26%) received a tracheostomy. There were 90 patients in Group I and 109 patients in Group II. There was no significant difference in the severity of the patients’ illness between the groups. The mortality rate at 3 months, 6 months, 1 year, and 2 years was 37%, 48%, 56%, and 58% in Group I, respectively, and 58%, 70%, 74%, and 77% in Group II, respectively (p< 0.01).ConclusionsEarly-intermediate (0-14 days) tracheostomy after cardiac surgery in patients requiring prolonged mechanical ventilation was associated with reduced mortality compared with late tracheostomy (≥15 days).