Tracheostomy: a risk factor for mediastinitis after cardiac operation

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Critical Care Medicine

Background:

• Coronary artery bypass grafting (CABG) is a common cardiac procedure.
• Tracheostomy is sometimes required post-CABG for respiratory support.
• The association between post-CABG tracheostomy and mediastinitis/mortality requires investigation.

Purpose of the Study:

• To determine if tracheostomy following CABG is associated with increased mediastinitis and mortality.
• To investigate if the timing of tracheostomy after CABG impacts mediastinitis risk.

Main Methods:

• Retrospective review of 6,057 patients undergoing CABG since March 1977.
• Identification of patients requiring tracheostomy and those developing mediastinitis.
• Mediastinitis diagnosis confirmed by positive culture of mediastinal tissue or fluid.

Main Results:

• Tracheostomy was performed in 1.45% (88/6,057) of CABG patients.
• Mediastinitis occurred in 8.6% (7/81) of tracheostomy patients versus 0.7% (44/5,969) of non-tracheostomy patients (p < 0.001).
• Mortality was 24.7% (20/81) in tracheostomy patients compared to 5.2% (316/5,969) in others (p < 0.001).

Conclusions:

• Tracheostomy after CABG is linked to higher rates of mediastinitis and mortality.
• The time interval between CABG and tracheostomy did not predict mediastinitis in this cohort.
• Larger studies are needed to confirm the lack of correlation between timing and mediastinitis.