Outcomes of tracheostomy after cardiac surgery through median sternotomy

Tracheostomy complications (TCs) can result in severe outcomes such as mediastinitis, yet their significance is often underestimated due to their frequent presentation as minor local infections. In patients undergoing tracheostomy following cardiac surgery via sternotomy, the anatomical proximity between the tracheostoma and sternotomy wound, along with systemic inflammation from cardiopulmonary bypass, may increase the risk of complication. However, clinical outcome studies in this field remain limited. In this study, we aimed to investigate the outcomes of tracheostomy after cardiac surgery through median sternotomy and identify perioperative factors associated with TCs.

In total, 1,689 patients underwent cardiac surgery between February 2014 and August 2024; among those patients, 85 (5%) required tracheostomy. After the exclusion of 21 patients who required thoracotomy or mini-thoracotomy, 64 patients (cardiac surgery through median sternotomy required tracheostomy) were ultimately enrolled and divided into TC (n=11) and no TC (N-TC; n=53) groups. Preoperative characteristics, intraoperative data, and early postoperative outcomes were compared between the groups. Multivariable analysis was performed to identify factors associated with TCs.

In total, 11 of 64 patients (17.2%) developed complications after tracheostomy, with an in-hospital mortality rate of 40.6% (26/64). A history of redo tracheostomy was significantly more prevalent (P=0.03) and the median units of packed red blood cells (pRBCs) transfused intraoperatively and on the day of cardiac surgery were significantly more in the TC group than in the N-TC group [12.0 (range, 6.0, 16.0) vs. 7.0 (range, 5.0, 9.0), P=0.042]. The intensive care unit stay was significantly longer in the TC group by 412 h (P=0.03). Use of the left internal mammary artery (odds ratio: 8.64, 95% confidence interval: 1.43-52.19, P=0.02) and the units of pRBCs transfused intraoperatively and on the day of cardiac surgery (odds ratio: 1.27, 95% confidence interval: 1.09-1.49, P=0.001) were significantly associated with TCs.

Patients who underwent tracheostomy after cardiac surgery through median sternotomy showed high early mortality and morbidity rates. The incidence of TCs was also high, underscoring the need for close monitoring of the tracheostomy site. Further research is warranted to investigate the long-term effects of these complications on patient outcomes.