Background
Liver transplant (LT) patients have an increased risk of postoperative respiratory failure requiring tracheostomy. This study sought to characterize objective clinical predictors of tracheostomy.
Material/Methods
The records for 2017 LT patients at a single institution were reviewed. Patients requiring tracheostomy were first compared with all other patients. A case-control subgroup analysis was conducted in which 98 tracheostomy patients were matched with 98 non-tracheostomy LT patients. For the case-control study, muscle mass was assessed using preoperative computed tomography scans.
Results
Among 2017 LT patients, 98 required tracheostomy (5%), with a 19% complication rate. Tracheostomy patients were older and had a higher model for end-stage liver disease score, a lower body mass index (BMI), and a greater smoking history. Tracheostomy patients had a longer hospital stay (45
vs.
10 days,
P
<0.001) and worse 1-year survival (65%
vs.
91%,
P
<0.001). Ten-year Cox regression patient survival for tracheostomy patients was significantly worse (32%
vs.
68%,
P
<0.001). In the case-control analysis, respiratory failure patients were older (
P
<0.01) and had a lower BMI (
P
=0.05). They also had a muscle mass deficit of −39% compared with matched LT controls (
P
<0.001). No significant differences were seen with pre-LT total protein or albumin or with forced expiratory volume in 1 s divided by forced vital capacity (FEV1/FVC) values.
Conclusions
Predictors for respiratory failure requiring post-LT tracheostomy include higher model for end-stage liver disease score, older age, lower BMI, greater smoking history, and worse sarcopenia. Patients requiring tracheostomy have dramatically longer hospital stays and worse survival.