Tracheostomy: a risk factor for mediastinitis after cardiac operation

Curtis, Jennifer; 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.

doi:10.1016/s0003-4975(01)02835-1

Cited by 56 publications

(35 citation statements)

References 14 publications

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“…Our multivariate analysis also identified diabetes, urgency status and RBC transfusions as predictors of DSWI. These trends are well supported by prior studies (5,6), who identified tracheostomy as a risk factor for DSWI and operative mortality. Curtis et al (6) reported 8.6% incidence of DSWI in tracheostomy patients compared to 0.7% in the non-tracheostomy patients.…”

Section: Discussionsupporting

confidence: 76%

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Association between post-sternotomy tracheostomy and deep sternal wound infection: a retrospective analysis

et al. 2016

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of the tracheostomy group. Seven of these 23 patients had DSWI after insertion of tracheostomy. DSWI was significantly higher in tracheostomy versus no-tracheostomy patients (10.2% vs. 0.48%; P<0.001). DSWI was also associated with higher mortality rates compared to non-DSWI patients (11.4% vs. 2.3%; P<0.001).Conclusions: The present study demonstrated that tracheostomy was an independent risk factor for post-sternotomy DSWI, and that DSWI was a predictor of mortality. For tracheostomy patients, coronary artery bypass grafting (CABG) procedures and longer durations of tracheostomy were strong predictors of DSWI. Across all sternotomy patients, tracheostomy, diabetes, urgency status and blood transfusions were significant risk factors for DSWI. As such, the decision for tracheostomy post-sternotomy should be carefully considered on a case by case basis.

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Section: Discussionsupporting

confidence: 76%

“…Several studies have suggested that microbial contamination and consecutive infection of the sternal wound with microbes from tracheostomy may increase the risk of DSWI and mediastinitis (5,6). It could be argued that in principle, delaying the tracheostomy could interfere less with early phase of sternal and incisional healing.…”

Section: Introductionmentioning

confidence: 99%

Association between post-sternotomy tracheostomy and deep sternal wound infection: a retrospective analysis

et al. 2016

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“…However, tracheostomy after cardiac surgery is associated with an increased incidence of deep sternal wound infection, 29,30 thus, determining the appropriate timing for tracheostomy is another important issue. Force et al commented that the timing of the tracheostomy does not play a major role in the development of deep sternal wound infection, 30 but we feel that early tracheostomy can lead to this fatal complication.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Prolonged Mechanical Ventilation Following Surgery for Acute Type A Aortic Dissection

Kimura

Tanaka

Kawahito

et al. 2008

Circ J

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ompared to the relatively favorable in-hospital outcomes of acute type B aortic dissection, 1,2 acute type A aortic dissection (AAAD) remains one of the most serious cardiovascular diseases associated with a high mortality. The latest report from the International Registry of Acute Aortic Dissection Investigators group indicated that in-hospital mortality remains high (163 of 682 patients (23.9%) with AAAD treated surgically between 1996 and 2003). 3 With such critical illness, some patients require prolonged mechanical ventilation (PMV) after surgery. Compared with patients who undergo other cardiac surgeries, patients with AAAD are more likely to suffer preoperative hemodynamic instability, organ malperfusion, and prolonged cardiopulmonary bypass (CPB) during surgery. In addition, re-exploration for bleeding and neurological deficits are common postoperative complications in these patients. 4 All these factors can contribute to PMV after AAAD surgery. 5 Another factor related to the PMV is systemic inflammatory response-related lung injury evoked by acute aortic dissection. 6,7 A number of studies regarding PMV following cardiac surgery have examined its predictors or its influence on clinical outcomes and costs. [8][9][10][11][12][13][14][15][16][17] However, little is known about PMV following AAAD surgery. The aim of this retrospective study was to identify predictors of PMV following AAAD surgery and to assess the influence of PMV on the short and long-term postoperative courses. MethodsFrom January 1997 through to December 2006, 243 consecutive patients with AAAD underwent emergency surgery at our hospital. Aortic dissection was diagnosed by means of enhanced computed tomography scan or echocardiography, and transesopageal echocardiography was used for confirmation when possible. In all patients, emergency surgery was performed within 14 days after the onset of symptoms; 90% of these surgeries were performed within 48 h. So that we could focus on PMV, 10 patients who died within 48 h after surgery were excluded from the study. Death within 48 h after surgery was due to profound cardiac failure (8 patients) or refractory bleeding (2 patients). The remaining 233 patients (120 men, 113 women, mean age: 63.4±11.2 years) were divided into 2 groups according to the duration of mechanical ventilation: those who were tracheally extubated within 48 h after admission to the intensive care unit (ICU) (group A, n=149) and those who required mechanical ventilation for more than 48 h (group B, n=84). Patients who were reintubated within 24 h after extubation were considered to have an interrupted period of ventilation. To identify the independent predictors for PMV, we compared 48 perioperative factors (25 preoperative factors and 23 intra or postoperative factors) between the 2 groups. Mortality and morbidity, length of the ICU and hospital stays, and long-term survival were compared

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“…There continues to be uncertainty as to the true nature of the relationship between tracheostomy and SWI, with recent publications both supporting and refuting tracheostomy as a cause of SWI post cardiac surgery. [5][6][7][8][9][10][11] Three large observational studies support tracheostomy as a risk factor for SWI. In a study of 6,057 patients undergoing isolated coronary artery bypass, Curtis et al 5 Two previous studies that failed to detect an association between tracheostomy and SWI were limited by small numbers of events, which precluded robust risk adjustment.…”

Section: Résumémentioning

confidence: 99%

“…[5][6][7][8][9][10][11] Three large observational studies support tracheostomy as a risk factor for SWI. In a study of 6,057 patients undergoing isolated coronary artery bypass, Curtis et al 5 Two previous studies that failed to detect an association between tracheostomy and SWI were limited by small numbers of events, which precluded robust risk adjustment. 7,8 It is obvious that patients in the group receiving tracheostomy differ greatly from the non-tracheostomy group.…”

Section: Résumémentioning

confidence: 99%

The association between tracheostomy and sternal wound infection in postoperative cardiac surgery patients

Sun

Boodhwani

Baer

et al. 2013

Can J Anesth/J Can Anesth

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Purpose To investigate whether tracheostomy increases the risk of sternal wound infection (SWI) post cardiac surgery. Methods All patients undergoing cardiac surgery via median sternotomy from September 1997 to October 2010 were included in this retrospective observational study. Primary exposure was tracheostomy performed during admission to the cardiac surgical intensive care unit. The primary outcome was SWI during hospital admission. Multivariable logistic regression was used to determine if tracheostomy was an independent predictor of SWI. Restriction and propensity score analyses were then used to assess if tracheostomy is a causal risk factor for SWI. Results Four hundred and eleven of 18,845 patients (2.2%) were treated with tracheostomy. Incidences of SWI in tracheostomy and non-tracheostomy groups were 19.5% (80/411) and 0.8% (154/18,434), respectively. Using multivariable logistic regression analysis, tracheostomy was found to be an independent predictor of SWI (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.9 to 4.2). In an analysis restricted to respiratory failure patients, tracheostomy was associated with sternal wound infection (OR 3.4; 95% CI 2.4 to 4.9). When the analysis was stratified by the risk of receiving tracheostomy as represented by propensity score (PS), 46 patients (12%) in the intermediate risk category (PS 0.2-0.4) had SWIs (adjusted OR 2.97; 95% CI 1.6 to 5.6), and 52 patients (14%) in the highest risk category (PS [ 0.4) had SWIs (OR 1.52; 95% CI 0.85 to 2.87). Discussion Our single-centre observational study of cardiac surgery patients found tracheostomy to be an independent risk factor for SWI. Our analysis showed a robust association when restricted to patients with respiratory failure and after the population was stratified by the propensity to have a tracheostomy. Résumé

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Tracheostomy: a risk factor for mediastinitis after cardiac operation

Cited by 56 publications

References 14 publications

Association between post-sternotomy tracheostomy and deep sternal wound infection: a retrospective analysis

Association between post-sternotomy tracheostomy and deep sternal wound infection: a retrospective analysis

Risk Factors for Prolonged Mechanical Ventilation Following Surgery for Acute Type A Aortic Dissection

The association between tracheostomy and sternal wound infection in postoperative cardiac surgery patients

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