• Jagan Devarajan, Amaresh Vydyanathan, Meng Xu, Sudish M Murthy, Kenneth R McCurry, Daniel I Sessler, Joseph Sabik, and C Allen Bashour.
• Department of General Anesthesia, Cleveland Clinic, Cleveland, OH 44195, USA.
• J. Am. Coll. Surg. 2012 Jun 1;214(6):1008-16.e4.

BackgroundThe best time to perform a tracheostomy in cardiac surgery patients who require prolonged postoperative mechanical ventilation remains unknown. The primary aim of this investigation was to determine if tracheostomy performed before postoperative day 10 improves patient outcomes.Study DesignWe conducted a retrospective review of prospectively collected patient information obtained from the Anesthesiology Institute Patient Registry on adult patients recovering from coronary artery bypass grafting and/or valve surgery. Demographic and comorbidity patient variables were obtained. Patients were divided into 2 groups based on the timing of their tracheostomy: early (less than 10 days) and late (14 to 28 days). The 2 patient groups were matched using propensity scores and compared on morbidity and in-hospital mortality outcomes. The primary outcomes measures were length of stay, morbidity, and in-hospital mortality.ResultsAfter propensity matching (n = 114 patients/group), early tracheostomy was associated with decreased in-hospital mortality (21.1% vs 40.4%, p = 0.002) and cardiac morbidity (14.0% vs 33.3%, p < 0.001), along with decreased ICU (median difference 7.2 days, p < 0.001) and hospital (median difference 7.5 days, p = 0.010) durations. The occurrence of sternal wound infection (6.0% vs 19.5%, p = 0.009) was less in the early tracheostomy group, but mediastinitis did not differ significantly (3.5% vs 7.0%, p = 0.24).ConclusionsTracheostomy within 10 postoperative days in cardiac surgery patients who require prolonged mechanical ventilation was associated with decreased length of stay, morbidity, and mortality.Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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