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Tracheostomy after major vascular surgery.

Daniel A Diedrich1, Mark T Keegan, Daniel R Brown

  • 1Department of Anesthesiology, Division of Critical Care, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.

Journal of Cardiothoracic and Vascular Anesthesia
|February 7, 2006
PubMed
Summary
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Tracheostomy after aortic aneurysm repair is linked to high in-hospital mortality. Patients surviving intensive care often require long-term ventilation, but chronic obstructive pulmonary disease may improve survival.

Area of Science:

  • Vascular Surgery
  • Critical Care Medicine
  • Respiratory Therapy

Background:

  • Major vascular surgery, including aortic aneurysm repair, can lead to prolonged hospitalization.
  • Tracheostomy is sometimes performed to facilitate mechanical ventilation weaning or manage secretions in these patients.

Purpose of the Study:

  • To investigate the outcomes of patients undergoing tracheostomy after aortic reconstruction for aneurysmal disease.
  • To identify factors associated with mortality and long-term outcomes in this patient cohort.

Main Methods:

  • Retrospective, observational study of 81 patients who had a tracheostomy after open thoracoabdominal or abdominal aortic aneurysm repair.
  • Data collected from a tertiary referral hospital's vascular surgical intensive care unit between 1993 and 2002.

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Main Results:

  • 40.7% of patients with tracheostomy after aortic repair did not survive to hospital discharge.
  • Postoperative sepsis (RR 2.45) and renal failure (RR 1.53) were associated with increased in-hospital mortality.
  • 39.5% of survivors were transferred to a chronic ventilator dependency unit.

Conclusions:

  • Tracheostomy following aortic reconstruction for aneurysmal disease is associated with a high mortality rate.
  • Preoperative chronic obstructive pulmonary disease diagnosis correlated with improved survival, while sepsis increased mortality.
  • Consider tracheostomy risks and benefits when counseling patients and families.