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Vol. 47. Issue 9.
Pages 516-525 (September 2023)
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Vol. 47. Issue 9.
Pages 516-525 (September 2023)
Original article
Early tracheostomy after cardiac surgery improves intermediate- and long-term survival
La traqueotomía temprana después de la cirugía cardíaca mejora la supervivencia intermedia y a largo plazo
Eitan Keizmana, Jonathan K. Frogelb, Eilon Rama, David Volvovitcha, Tamer Jamala, Shany Levina, Ehud Raanania, Leonid Sternika, Alexander Kogana,c,
Corresponding author

Corresponding author at: Department of Cardiac Surgery, Cardiac Surgery ICU, Sheba Medical Center, Tel Hashomer, 52621 Israel.
a Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Centre, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
b Department of Anaesthesiology, Sheba Medical Centre, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
c Cardiac Surgery ICU, Sheba Medical Centre, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
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Tables (3)
Table 1. Perioperative patient’s data.
Table 2. Perioperative patient's parameters and mortality according to groups.
Table 3. Cox Regression for mortality with tracheostomy as a time-varying covariate.
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Complicated post-cardiac surgery course, can lead to both prolonged ICU stay and ventilation, and may require a tracheostomy. This study represents the single-center experience with post-cardiac surgery tracheostomy. The aim of this study was to assess the timing of tracheostomy as a risk factor for early, intermediate, and late mortality. The study’s second aim was to assess the incidence of both superficial and deep sternal wound infections.


Retrospective study of prospectively collected data.


Tertiary hospital.


Patients were divided into 3 groups, according to the timing of tracheostomy; early (4−10 days); intermediate (11−20 days) and late (≥21 days).



Main variables of interest

The primary outcomes were early, intermediate, and long-term mortality. The secondary outcome was the incidence of sternal wound infection.


During the 17-year study period, 12,782 patients underwent cardiac surgery, of whom 407 (3.18%) required postoperative tracheostomy. 147 (36.1%) had early, 195 (47.9%) intermediate, and 65 (16%) had a late tracheostomy. Early, 30-day, and in-hospital mortality was similar for all groups. However, patients, who underwent early- and intermediate tracheostomy, demonstrated statistically significant lower mortality after 1- and 5-year (42.8%; 57.4%; 64.6%; and 55.8%; 68.7%; 75.4%, respectively; P < .001). Cox model demonstrated age [1.025 (1.014–1.036)] and timing of tracheostomy [0.315 (0.159−0.757)] had significant impacts on mortality.


This study demonstrates a relationship between the timing of tracheostomy after cardiac surgery and mortality: early tracheostomy (within 4−10 days of mechanical ventilation) is associated with better intermediate- and long-term survival.

Cardiac surgery
Prolonged mechanical ventilation

La evolución complicada de un postoperatorio de сirugía cardiaca puede dar lugar tanto a una estancia prolongada en UCI como a ventilación mecánica prolongada y puede requerir de una traqueotomía. Este estudio presenta la experiencia acumulada sobre traqueostomía en el postoperatorio de cirugía cardiaca en un único hospital.El objetivo era evaluar el momento de la realización de la traqueotomía como factor de riesgo de mortalidad temprana, intermedia y tardía.


Estudio retrospectivo.


Hospital terciario.


Pacientes fueron divididos en 3 grupos según el momento de la traqueotomía; temprano (4−10 días); intermedio (11−20 días); tardío (≥21 días).



Variables de interés principals

Los resultados primarios fueron la mortalidad en cada grupo.


Durante los 17 años de duración del estudio, de los 12.782 pacientes sometidos a cirugía cardíaca, 407 (3,18%) requirieron traqueotomía postoperatoria. Se practicaron 147 (36,1%) traqueotomías tempranas, 195 (47,9%) intermedias y 65 (16%) tardías. La mortalidad temprana, a los 30 días dentro del marco hospitalario, fue similar en todos los grupos. Sin embargo, las traqueotomía temprana e intermedia demostraron una mortalidad inferior estadísticamente significativa a 1 y 5 años (42,8%; 57,4%; 64,6%; y 55,8%; 68,7%; 75,4%, respectivamente; P < ,001). El modelo de Cox demostró que la edad [1,025 (1,014–1,036)] y el momento [0,315 (0,159–0,757)] impacta significativamente la mortalidad.


La traqueotomía temprana (dentro de los 4−10 días de ventilación mecánica) en el postoperatorio de cirugía cardíaca se asoció con una mejor supervivencia a medio/largo plazo.

Palabras clave:
Cirugía cardiaca
Ventilación mecánica prolongada


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