Predictors of and outcomes related to perioperative myocardial injury post-tracheotomy

Perioperative myocardial injury (PMI) is associated with increased mortality. We describe risk factors for and outcomes of PMI in patients undergoing tracheotomy.

Retrospective study of patients undergoing tracheotomy from 2007 to 2016. PMI was defined by a postoperative cardiac troponin I (cTnI) > 99th percentile. Demographics and comorbidities were extracted from the electronic medical record and compared between patients with and without PMI. Significant univariate predictors were included in a multivariable logistic regression model to determine independent predictors of PMI. Thirty-day and 1-year mortality of patients with and without PMI were compared.

Of 861 patients undergoing tracheotomy, 41 (4.76%) had PMI and 820 (95.24%) did not. PMI was associated with higher mortality at both 30 days (40.5% vs. 11.2%, p < 0.001) and 1 year (73.2% vs. 44.1%, p < 0.001). Patients with PMI were older (median age 65 vs. 60, p = 0.002) and more likely to have prior myocardial infarction (MI) (36.6% vs. 10.7%, p < 0.001) and chronic kidney disease (31.7% vs. 16.7%, p = 0.024). Cancer diagnosis was associated with a lower risk of PMI (24.4% vs. 41.8%, p = 0.041). Older age (odds ratio [OR] = 1.033, p < 0.001) and prior MI (OR = 3.686, p < 0.001) were independently associated with PMI.

Patients with PMI following tracheotomy had increased short- and long-term mortality. Increased age and history of prior MI were independent predictors of PMI, while cancer was associated with a lower risk of PMI following tracheotomy. ICU patients likely have more acute ailments contributing to a higher risk of PMI and poorer outcomes compared to cancer patients requiring tracheotomy. We propose routine screening for PMI with cTnI in the postoperative period in all tracheotomy patients.