Tracheostomy: a risk factor for mediastinitis after cardiac operation

• Published in: The Annals of thoracic surgery Vol. 72; no. 3; pp. 731 - 734
• Main Authors: Curtis, Jack J, Clark, Nicole C, McKenney, Charlotte A, Walls, Joseph T, Schmaltz, Richard A, Demmy, Todd L, Jones, James W, Wilson, William R, Wagner-Mann, Colette C
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-09-2001
• Subjects: Aged; Aged, 80 and over; Coronary Artery Bypass; Female; Humans; Male; Mediastinitis - etiology; Mediastinitis - mortality; Middle Aged; Postoperative Care; Retrospective Studies; Risk Factors; Sternum - surgery; Surgical Wound Infection - etiology; Time Factors; Tracheostomy - adverse effects; Tracheostomy - mortality
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(01)02835-1

Background. We studied whether tracheostomy after coronary artery bypass grafting (CABG) is associated with higher incidence of mediastinitis and mortality, and whether shorter intervals between median sternotomy and tracheotomy are associated with higher incidence of mediastinitis.
Methods. Patients (n = 6,057) undergoing CABG since March 1977 were reviewed. Patients requiring tracheostomy and those developing mediastinitis were identified. Mediastinitis diagnosis required positive culture of mediastinal tissue or fluid.
Results. After CABG, 88 patients had tracheostomy performed (1.45%). Seven patients receiving tracheostomy after developing mediastinitis were excluded. Of the remaining 81 patients, 7 developed mediastinitis (8.6%) compared with 44 of 5,969 (0.7%) who did not require tracheostomy (
p < 0.001). Mortality in tracheostomy patients was 24.7% (20 of 81) compared with 5.2% in patients not requiring tracheostomy (316 of 5,969;
p < 0.001). Patients not developing mediastinitis had tracheostomy placement an average of 25 days after CABG compared with 18.7 days for those developing mediastinitis (
p = 0.141).
Conclusions. Tracheostomy after CABG is associated with increased incidence of mediastinitis and mortality. In this review, the time interval between CABG and tracheostomy was not predictive of mediastinitis. A larger sample size would be required to be confident that there is no correlation.