Tracheostomy After Thoracoabdominal Aortic Aneurysm Repair: Risk Factors and Outcomes

• Published in: The Annals of thoracic surgery Vol. 108; no. 3; pp. 778 - 784
• Main Authors: Songdechakraiwut, Tanuntorn, Aftab, Muhammad, Chatterjee, Subhasis, Green, Susan Y., Price, Matt D., Preventza, Ourania, de la Cruz, Kim I., LeMaire, Scott A., Coselli, Joseph S.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-09-2019
• Subjects: Aged; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Blood Vessel Prosthesis Implantation - methods; Blood Vessel Prosthesis Implantation - mortality; Cohort Studies; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Length of Stay; Logistic Models; Male; Middle Aged; Multivariate Analysis; Postoperative Care - methods; Prognosis; Retrospective Studies; Risk Assessment; Survival Analysis; Tracheostomy - methods; Tracheostomy - mortality; Treatment Outcome
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2019.02.063

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.
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.
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.
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.