Earlier versus later tracheostomy in patients with respiratory failure after cardiac surgery in the United States

Objectives The objective of this study was to evaluate the impact of timing of tracheostomy on outcomes of patients with respiratory failure after cardiac surgery. Design Retrospective analysis of national database. Setting United States hospitals. Participants A weighted estimate of 2,063,227 patients (475,773 case records) undergoing cardiac surgery identified from the Nationwide Inpatient Sample between 2002-2010 Interventions Early versus late tracheostomy. Measurements and Main Results The incidence of postoperative respiratory failure was 7.8%. The strongest independent predictors of respiratory failure included female gender (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.28-1.31), age (OR 1.13 for each decade, 95% CI 1.12-1.13), chronic obstructive airways disease (OR 2.16, 95% CI 2.13-2.19), chronic renal insufficiency (OR 2.28, 95% CI 2.25-2.31), and valve surgery (OR 1.62, 95% CI 1.6-1.64). Tracheostomy was performed in 22.9% of patients with respiratory failure; 13.6% of tracheostomies were performed within 5 days of surgery (or within 5 days of intubation in patients who underwent reintubation), and 20.5% were performed on postoperative day 21 or later. Compared with tracheostomy performed within 5 days of intubation, there was a near-stepwise increase in risk of mortality with delayed tracheostomy performed between days 11-15 (OR 1.29, 95% CI 1.16-1.43), days 16-20 (OR 1.25, 95% CI 1.11-1.41), and day 21 or later (OR 1.53, 95% CI 1.37-1.71). Conclusions In this analysis of outcomes of patients with respiratory failure after cardiac surgery in the United States, deferring tracheostomy did not appear to improve patient outcomes after cardiac surgery.