Predicting risk of tracheostomy after cardiac surgery: a decade of insights from nearly 10,000 patients.

OBJECTIVE

Studies have shown that requiring tracheostomy following cardiac surgery has significant implications on outcomes. This study proposes a risk stratification model to predict the likelihood of requiring a tracheostomy after cardiac surgery.

METHODS

Patients who underwent cardiac surgery between January 2010 and December 2019 were analyzed. Kaplan-Meier analysis and log-rank test were used to estimate and compare survival between cohorts. A prediction model for the need for postoperative tracheostomy was developed with logistic regression combined with undersampling analysis.

RESULTS

A total of 9849 patients underwent cardiac surgery, and 176 (1.8%) required postoperative tracheostomy. Tracheostomy patients were older (mean age 68.4 ± 12.3 vs 65.9 ± 11.2 years;  < 0.01) and more likely female (43.8% vs 28.5%;  < 0.01). Predictors for requiring tracheostomy included hypertension (odds ratio [OR] 1.91;  = 0.05), New York Heart Association III/IV (OR 2.68;  < 0.001), chronic lung disease (OR 3.27;  < 0.001), and history of prior myocardial infarction (OR 3.32;  < 0.001). Three-year Kaplan-Meier survival was worse in patients who received tracheostomy (log-rank  < 0.001).

CONCLUSIONS

A risk prediction model for requiring tracheostomy after cardiac surgery is proposed in this study. A history of New York Heart Association III/IV, chronic lung disease, and myocardial infarction as well as undergoing valve surgeries were associated with increased risk of requiring a tracheostomy.