Optimum Timing of Tracheostomy Following Cardiac Surgery: Descriptive Claims Database Study

BACKGROUND Suitable tracheostomy timing after cardiac surgery remains controversial; hence, this study compared the effectiveness of early and late tracheostomy after cardiac surgery. METHODS Using the nationwide administrative claims database in Japan, patients who underwent cardiac surgery 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 two groups: an early group (undergone tracheostomy 1–14 days post-surgery) and a late group (undergone tracheostomy 15–30 days post-surgery). Baseline characteristics were adjusted by propensity score weighting. RESULTS Of 1,240 patients who underwent cardiac surgery and postoperative tracheostomy, 784 were included in the main analysis cohort. As the number of days between the surgery 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 [OR], 0.65; 95% confidence interval [CI], 0.46–0.91; P=.01) was lower in the early group than in the early group, the incidence of deep sternal wound infection (OR, 0.59; 95% CI, 0.23–1.52; P=.27) was not significantly different between the two groups, and the early group had more ventilator-free days compared to 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.