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Tracheostomy: a risk factor for mediastinitis after cardiac operation

J J Curtis1, N C Clark, C A McKenney

  • 1Department of Cardiothoracic Surgery, University of Missouri, Columbia, USA. curtisj@health.missouri.edu

The Annals of Thoracic Surgery
|September 22, 2001
PubMed

Insights

Tracheostomy after coronary artery bypass grafting (CABG) increases mediastinitis and mortality risks. Shorter intervals between CABG and tracheostomy were not linked to mediastinitis in this study.

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.
Abstract

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