Optimum Timing of Tracheostomy After Cardiac Operation: Descriptive Claims Database Study

Abstract

Background: Suitable tracheostomy timing after cardiac operation remains controversial; hence, this study compared the effectiveness of early and late tracheostomy after cardiac operation. Methods: By using the nationwide administrative claims database in Japan, patients who underwent cardiac operation between April 2010 and March 2020 were identified and included in this study. In-hospital mortality, incidence of deep sternal wound infection, and ventilator-free days were analyzed and compared by dividing patients into 2 groups: an early group (patients who underwent tracheostomy 1-14 days postoperatively) and a late group (patients who underwent tracheostomy 15-30 days postoperatively). Baseline characteristics were adjusted by propensity score weighting. Results: Of 1240 patients who underwent cardiac operation and postoperative tracheostomy, 784 were included in the main analysis cohort. As the number of days between the operation and tracheostomy increased, in-hospital mortality increased, whereas ventilator-free days decreased. The early and late groups comprised 284 and 326 patients, respectively. After adjustment of baseline characteristics, the in-hospital mortality (odds ratio, 0.65; 95% CI, 0.46-0.91; P = .01) was lower in the early group than in the late group, the incidence of deep sternal wound infection (odds ratio, 0.59; 95% CI, 0.23-1.52; P = .27) was not significantly different between the 2 groups, and the early group had more ventilator-free days compared with the late group (mean difference, 5.1; 95% CI, 3.6-6.5; P < .001). Conclusions: Early tracheostomy may be considered in patients expected to require prolonged ventilation.