Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
Ann Thorac Surg. 2021 Feb;111(2):594-599. doi: 10.1016/j.athoracsur.2020.05.052. Epub 2020 Jun 30.
The long-term implications of tracheostomy in cardiac surgical patients are largely unknown. We sought to investigate outcomes including decannulation and long-term mortality in a population of post-cardiac surgery patients.
All patients undergoing cardiac surgery at a single institution between 1997 and 2016 were evaluated for postoperative tracheostomy placement, time to decannulation, and mortality. Patients were stratified by tracheostomy placement, as well as by successful decannulation for comparison. Kaplan-Meier analysis identified time to decannulation and mortality and a Fine-Gray's competing risk regression, accounting for mortality, identified predictors of time to decannulation.
Of 14,600 total cardiac surgery patients, only 309 required tracheostomy. Patients with tracheostomy had high rates of perioperative comorbidities, including 60% with heart failure and 24% with postoperative stroke. Tracheostomy patients had high short-term and long-term mortality, with a median survival of 152 days, 1-year survival of 41%, and 5-year survival of 29.1%. Patients remained with tracheostomy in place for a median of 59 days, with a 1-year decannulation rate of 80% in living patients. Patients with older age (hazard ratio 0.98, P = .01), chronic lung disease (hazard ratio 0.66, P = .03), and preoperative or postoperative dialysis (hazard ratio 0.45, P < .01) were less likely to have their tracheostomy removed.
Tracheostomy is associated with poor long-term survival of cardiac surgery patients. However, patients who do survive have a short duration of tracheostomy with almost all surviving patients eventually decannulated. This finding provides valuable information for pre-procedural counseling for these high-risk patients and their families.
心脏外科患者行气管切开术的长期影响尚不清楚。我们旨在调查心脏手术后患者的脱机和长期死亡率等结局。
对 1997 年至 2016 年期间在一家机构行心脏手术的所有患者进行了术后气管切开术置管、脱机时间和死亡率评估。根据气管切开术置管情况以及脱机成功情况对患者进行分层，以进行比较。通过 Kaplan-Meier 分析确定脱机时间和死亡率，通过 Fine-Gray 竞争风险回归分析（考虑死亡率）确定脱机时间的预测因素。
在 14600 例心脏手术患者中，仅有 309 例需要气管切开术。行气管切开术的患者围手术期合并症发生率较高，包括 60%的心衰和 24%的术后卒中。气管切开术患者短期和长期死亡率均较高，中位生存期为 152 天，1 年生存率为 41%，5 年生存率为 29.1%。患者带管中位时间为 59 天，有创通气患者 1 年脱机率为 80%。年龄较大（风险比 0.98，P=.01）、慢性肺部疾病（风险比 0.66，P=.03）和术前或术后透析（风险比 0.45，P <.01）的患者气管切开管更不易被移除。
气管切开术与心脏外科患者的长期生存不良相关。然而，存活下来的患者带管时间较短，几乎所有存活患者最终都脱机。这一发现为这些高危患者及其家属提供了有价值的术前咨询信息。
