Tracheostomy after cardiac operations: in-hospital and long-term survival

Patients with ventilator dependency after cardiac operations may require a tracheostomy. This study determined the hospital and postdischarge outcome in a series of patients who underwent a tracheostomy due to ventilator dependency after cardiac operations.

Medical records of cardiac surgical patients were retrospectively reviewed for preoperative, intraoperative, and postoperative variables, and also prospective follow-up for all-cause mortality. All adult patients treated with tracheostomy due to postoperative ventilator dependency between January 1, 2004, and December 31, 2009, were admitted to the study. Statistical methods included a multivariable logistic regression analysis for hospital mortality and a Kaplan-Meier analysis with multivariable Cox regression model for postdischarge mortality.

The study group included 131 patients. The hospital mortality rate was 49%. The only independent predictor for hospital mortality was the number of fresh frozen plasma units transfused during the hospital stay (6% mortality risk increase per each unit transfused). Survival rate for patients discharged from the hospital was 61% at 1 year, 49% at 2 years, 45% at 3 years, and 34% at 5 years. Factors affecting death after discharge were concomitant postoperative heart failure (hazard ratio, 2.6) and the length of ventilator dependency.

Patients with a respiratory failure without associated heart failure or neurologic dysfunction have a significantly better long-term outcome. Caution should be applied in the use of fresh frozen plasma in patients with postoperative respiratory failure and ventilator dependency requiring a tracheostomy.