A Predictive Scoring Model for Postoperative Tracheostomy in Patients Who Underwent Cardiac Surgery

Abstract

BackgroundA subset of patients require a tracheostomy as respiratory support in a severe state after cardiac surgery. There are limited data to assess the predictors for requiring postoperative tracheostomy (POT) in cardiac surgical patients.MethodsThe records of adult patients who underwent cardiac surgery from 2016 to 2019 at our institution were reviewed. Univariable analysis was used to assess the possible risk factors for POT. Then multivariable logistic regression analysis was performed to identify independent predictors. A predictive scoring model was established with predictor assigned scores derived from each regression coefficient divided by the smallest one. The area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test were used to evaluate the discrimination and calibration of the risk score, respectively.ResultsA total of 5,323 cardiac surgical patients were included, with 128 (2.4%) patients treated with tracheostomy after cardiac surgery. Patients with POT had a higher frequency of readmission to the intensive care unit (ICU), longer stay, and higher mortality (p < 0.001). Mixed valve surgery and coronary artery bypass grafting (CABG), aortic surgery, renal insufficiency, diabetes mellitus, chronic obstructive pulmonary disease (COPD), pulmonary edema, age >60 years, and emergent surgery were independent predictors. A 9-point risk score was generated based on the multivariable model, showing good discrimination [the concordance index (c-index): 0.837] and was well-calibrated.ConclusionsWe established and verified a predictive scoring model for POT in patients who underwent cardiac surgery. The scoring model was conducive to risk stratification and may provide meaningful information for clinical decision-making.

Nomogram and Risk Calculator for Postoperative Tracheostomy after Heart Valve Surgery

“…Undergoing a tracheostomy is an important indicator of the increased risk of poor prognoses in patients undergoing cardiovascular surgeries [ 3 , 7 , 9 , 20 ], which was again confirmed in the current study. Due to the difference of surgical populations in different studies, the reported rates of POTs in the previous literature were quite different [ 3 , 7 , 8 , 9 , 10 , 11 ]. The overall incidence rate of POTs after HVS was 1.8% in our analysis, falling within the range of incidence rates reported in the previous literature [ 3 , 12 , 13 ].…”

“…Being of an older age was identified to associate with a higher risk of POTs in the current study; however, the results of whether the risk of POTs would increase with age were inconsistent in previous studies, which may be due to the difference in disease types and study populations [ 4 , 22 , 23 ]. Diabetes mellitus and pulmonary edema as risk factors for POTs have also been reported in previous studies, which may be mainly associated with higher risks of various pulmonary complications [ 7 , 24 , 25 ]. The relationship between combined aortic surgery and ventilation dependence was reported a long time ago, and patients undergoing aortic procedures have been identified to have a higher risk of respiratory failure [ 26 , 27 ].…”

“…Postoperative complications are prevalent after cardiovascular surgery, and a postoperative tracheostomy (POT) is often required to strengthen airway management when respiratory failure, circulatory failure, multiple organ dysfunction, and other critical adverse events develop [ 1 , 2 , 3 ]. As an important indicator of poor prognoses, POT operations often indicate a higher risk of mortality, prolonged hospital stay, increased medical burden, and declined quality of life [ 4 , 5 , 6 , 7 ]. The incidence of POTs varies widely in the previous literature due to the different surgical populations in different studies [ 3 , 7 , 8 , 9 , 10 , 11 ].…”

“…As an important indicator of poor prognoses, POT operations often indicate a higher risk of mortality, prolonged hospital stay, increased medical burden, and declined quality of life [ 4 , 5 , 6 , 7 ]. The incidence of POTs varies widely in the previous literature due to the different surgical populations in different studies [ 3 , 7 , 8 , 9 , 10 , 11 ]. Compared to other surgical types, patients undergoing cardiovascular surgery have been reported to have a relatively higher POT rate, mostly in the range of 1.4–11.8% [ 3 , 12 , 13 ].…”

Nomogram and risk calculator for severe hypoxemia after heart valve surgery

“…Weiss and Rady et al reported that emergency surgery correlated significantly with time to extubation and lung injury, and was independent predictor of early postoperative pulmonary dysfunction ( 27 , 28 ). Previous studies have identified the close relationship between renal insufficiency and various postoperative complications after cardiovascular surgery, such as hypoxemia, pneumonia, hyperlactatemia, and tracheostomy ( 3 , 29 – 33 ). Although the related researches on the relationship between renal insufficiency and hypoxemia are limited and the exact mechanisms remain to be further investigated, we guess that inflammatory responses, erythropoietin production by the kidney, and the subsequent oxygen delivery may be involved ( 34 ).…”