• Alessandro Affronti, Francesco Casali, Paolo Eusebi, Cristina Todisco, Francesca Volpi, Virginia Beato, Emilia Virginia Manini, Giulia Scopetani, and Temistocle Ragni.
• Department of Cardiac Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy. Electronic address: alessandroaffronti@yahoo.it.
• J. Cardiothorac. Vasc. Anesth. 2019 Jan 1; 33 (1): 82-90.

ObjectivesTo evaluate whether early tracheostomy is associated with better outcomes in mechanical ventilation-dependent patients after cardiac surgery compared with a late tracheostomy.DesignRetrospective, observational study.SettingCardiac surgical intensive care unit (ICU) of a tertiary care center.ParticipantsAll patients who underwent tracheostomy after cardiac surgery between 2004 and 2015 were subdivided into the following 2 groups according to the timing of tracheostomy: "early" if the tracheostomy was performed before the 14th postoperative day and "late" from the 14th postoperative day onward.InterventionsEarly versus late tracheostomy.Measurements And Main ResultsDuring the study period, 112 of 5,148 patients (2.2%) underwent tracheostomy after cardiac surgery. Early tracheostomy was performed in 62 patients, and 50 patients underwent late tracheostomy. Both groups of patients were similar in terms of preoperative and intraoperative characteristics, perioperative risk, and postoperative complications. Patients in the early group had a significantly shorter ventilation time (31.3 ± 23.6 v 39.4 ± 22.4 d; p = 0.034), shorter ICU stay (37.7 ± 21.7 v 46.4 ± 25 d; p = 0.025), and a shorter hospital stay (53.4 ± 29.3 v 66.8 ± 38.5 d; p = 0.020). There were no intergroup differences in weaning rates and in-hospital, 3-month, and 1- and 2-year mortality.ConclusionsIn this study, early tracheostomy after cardiac surgery in patients requiring prolonged mechanical ventilation was associated with a shorter ventilation time and ICU and hospital stay, but did not result in a lower in-hospital and long-term mortality rate.Copyright © 2018 Elsevier Inc. All rights reserved.

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