Predictors of and outcomes related to perioperative myocardial injury post-tracheotomy.

Abstract

Introduction: Perioperative myocardial injury (PMI) is associated with increased mortality. We describe risk factors for and outcomes of PMI in patients undergoing tracheotomy.

Methods: Retrospective study of patients undergoing tracheotomy from 2007 to 2016. PMI was defined by a postoperative cardiac troponin I (cTnI) > 99th percentile. Demographics and comorbidities were extracted from the electronic medical record and compared between patients with and without PMI. Significant univariate predictors were included in a multivariable logistic regression model to determine independent predictors of PMI. Thirty-day and 1-year mortality of patients with and without PMI were compared.

Results: Of 861 patients undergoing tracheotomy, 41 (4.76%) had PMI and 820 (95.24%) did not. PMI was associated with higher mortality at both 30 days (40.5% vs. 11.2%, p < 0.001) and 1 year (73.2% vs. 44.1%, p < 0.001). Patients with PMI were older (median age 65 vs. 60, p = 0.002) and more likely to have prior myocardial infarction (MI) (36.6% vs. 10.7%, p < 0.001) and chronic kidney disease (31.7% vs. 16.7%, p = 0.024). Cancer diagnosis was associated with a lower risk of PMI (24.4% vs. 41.8%, p = 0.041). Older age (odds ratio [OR] = 1.033, p < 0.001) and prior MI (OR = 3.686, p < 0.001) were independently associated with PMI.

Conclusion: Patients with PMI following tracheotomy had increased short- and long-term mortality. Increased age and history of prior MI were independent predictors of PMI, while cancer was associated with a lower risk of PMI following tracheotomy. ICU patients likely have more acute ailments contributing to a higher risk of PMI and poorer outcomes compared to cancer patients requiring tracheotomy. We propose routine screening for PMI with cTnI in the postoperative period in all tracheotomy patients.