Tanuntorn Songdechakraiwut1, Muhammad Aftab2, Subhasis Chatterjee3, Susan Y Green4, Matt D Price4, Ourania Preventza1, Kim I de la Cruz1, Scott A LeMaire5, Joseph S Coselli1. 1. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas. 2. Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Aurora, Colorado. 3. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas. 4. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas. 5. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas. Electronic address: slemaire@bcm.edu.
Abstract
BACKGROUND: Respiratory failure, the most frequent complication after thoracoabdominal aortic aneurysm (TAAA) repair, necessitates tracheostomy in severe cases. We examined risk factors for and outcomes of tracheostomy after TAAA repair. METHODS: We reviewed the records of 1267 consecutive patients who underwent TAAA repair. Patients with a preexisting tracheostomy were excluded. Extensive repairs (Crawford extent I or II) were performed in 716 patients (56.6%). Stepwise logistic regression analysis was used to identify risk factors for postrepair tracheostomy. RESULTS: Tracheostomy was necessary in 140 patients (11.1%). Operative mortality was significantly higher in patients with tracheostomy (27.9%) than in those without (5.8%; p < 0.001). As expected, tracheostomy patients had longer intensive care unit stays (24 vs 4 days, p < 0.001) and hospital stays (57 vs 10 days, p < 0.001) than nontracheostomy patients. Patients with tracheostomy were frequently transferred for additional long-term acute care or hospitalization (107, 76.4%), and many died after transfer (24/107, 22.4%). Kaplan-Meier curves showed markedly poorer late survival in patients with tracheostomy than in those without (47.9% ± 4.3% vs 87.3% ± 1.0% at 1 year; 27.8% ± 4.8% vs 68.6% ± 1.6% at 5 years). Independent predictors of post-TAAA repair tracheostomy included acute aortic dissection, chronic renal insufficiency, underweight body mass index, hypertension, history of stroke, extent II repair, diabetes, age at least 70 years, and greater platelet transfusion volume. CONCLUSIONS: Patients who undergo tracheostomy after TAAA repair have a high risk of early and late mortality as well as prolonged hospitalization. Strategies for improving survival outcomes in tracheostomy patients warrant investigation.
BACKGROUND:Respiratory failure, the most frequent complication after thoracoabdominal aortic aneurysm (TAAA) repair, necessitates tracheostomy in severe cases. We examined risk factors for and outcomes of tracheostomy after TAAA repair. METHODS: We reviewed the records of 1267 consecutive patients who underwent TAAA repair. Patients with a preexisting tracheostomy were excluded. Extensive repairs (Crawford extent I or II) were performed in 716 patients (56.6%). Stepwise logistic regression analysis was used to identify risk factors for postrepair tracheostomy. RESULTS: Tracheostomy was necessary in 140 patients (11.1%). Operative mortality was significantly higher in patients with tracheostomy (27.9%) than in those without (5.8%; p < 0.001). As expected, tracheostomy patients had longer intensive care unit stays (24 vs 4 days, p < 0.001) and hospital stays (57 vs 10 days, p < 0.001) than nontracheostomy patients. Patients with tracheostomy were frequently transferred for additional long-term acute care or hospitalization (107, 76.4%), and many died after transfer (24/107, 22.4%). Kaplan-Meier curves showed markedly poorer late survival in patients with tracheostomy than in those without (47.9% ± 4.3% vs 87.3% ± 1.0% at 1 year; 27.8% ± 4.8% vs 68.6% ± 1.6% at 5 years). Independent predictors of post-TAAA repair tracheostomy included acute aortic dissection, chronic renal insufficiency, underweight body mass index, hypertension, history of stroke, extent II repair, diabetes, age at least 70 years, and greater platelet transfusion volume. CONCLUSIONS:Patients who undergo tracheostomy after TAAA repair have a high risk of early and late mortality as well as prolonged hospitalization. Strategies for improving survival outcomes in tracheostomy patients warrant investigation.
Authors: Dashuai Wang; Su Wang; Yifan Du; Yu Song; Sheng Le; Hongfei Wang; Anchen Zhang; Xiaofan Huang; Long Wu; Xinling Du Journal: Front Cardiovasc Med Date: 2022-01-28