{"title":"心脏手术后气管切开的最佳时机:描述性索赔数据库研究","authors":"","doi":"10.1016/j.atssr.2024.04.029","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Suitable tracheostomy timing after cardiac operation remains controversial; hence, this study compared the effectiveness of early and late tracheostomy after cardiac operation.</p></div><div><h3>Methods</h3><p>By using the nationwide administrative claims database in Japan, patients who underwent cardiac operation between April 2010 and March 2020 were identified and included in this study. In-hospital mortality, incidence of deep sternal wound infection, and ventilator-free days were analyzed and compared by dividing patients into 2 groups: an early group (patients who underwent tracheostomy 1-14 days postoperatively) and a late group (patients who underwent tracheostomy 15-30 days postoperatively). Baseline characteristics were adjusted by propensity score weighting.</p></div><div><h3>Results</h3><p>Of 1240 patients who underwent cardiac operation and postoperative tracheostomy, 784 were included in the main analysis cohort. As the number of days between the operation and tracheostomy increased, in-hospital mortality increased, whereas ventilator-free days decreased. The early and late groups comprised 284 and 326 patients, respectively. After adjustment of baseline characteristics, the in-hospital mortality (odds ratio, 0.65; 95% CI, 0.46-0.91; <em>P</em> = .01) was lower in the early group than in the late group, the incidence of deep sternal wound infection (odds ratio, 0.59; 95% CI, 0.23-1.52; <em>P</em> = .27) was not significantly different between the 2 groups, and the early group had more ventilator-free days compared with the late group (mean difference, 5.1; 95% CI, 3.6-6.5; <em>P</em> < .001).</p></div><div><h3>Conclusions</h3><p>Early tracheostomy may be considered in patients expected to require prolonged ventilation.</p></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772993124002134/pdfft?md5=1b3554c2bd274a8e02ee0c198dc9bc5d&pid=1-s2.0-S2772993124002134-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Optimum Timing of Tracheostomy After Cardiac Operation: Descriptive Claims Database Study\",\"authors\":\"\",\"doi\":\"10.1016/j.atssr.2024.04.029\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Suitable tracheostomy timing after cardiac operation remains controversial; hence, this study compared the effectiveness of early and late tracheostomy after cardiac operation.</p></div><div><h3>Methods</h3><p>By using the nationwide administrative claims database in Japan, patients who underwent cardiac operation between April 2010 and March 2020 were identified and included in this study. In-hospital mortality, incidence of deep sternal wound infection, and ventilator-free days were analyzed and compared by dividing patients into 2 groups: an early group (patients who underwent tracheostomy 1-14 days postoperatively) and a late group (patients who underwent tracheostomy 15-30 days postoperatively). Baseline characteristics were adjusted by propensity score weighting.</p></div><div><h3>Results</h3><p>Of 1240 patients who underwent cardiac operation and postoperative tracheostomy, 784 were included in the main analysis cohort. As the number of days between the operation and tracheostomy increased, in-hospital mortality increased, whereas ventilator-free days decreased. The early and late groups comprised 284 and 326 patients, respectively. After adjustment of baseline characteristics, the in-hospital mortality (odds ratio, 0.65; 95% CI, 0.46-0.91; <em>P</em> = .01) was lower in the early group than in the late group, the incidence of deep sternal wound infection (odds ratio, 0.59; 95% CI, 0.23-1.52; <em>P</em> = .27) was not significantly different between the 2 groups, and the early group had more ventilator-free days compared with the late group (mean difference, 5.1; 95% CI, 3.6-6.5; <em>P</em> < .001).</p></div><div><h3>Conclusions</h3><p>Early tracheostomy may be considered in patients expected to require prolonged ventilation.</p></div>\",\"PeriodicalId\":72234,\"journal\":{\"name\":\"Annals of thoracic surgery short reports\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2772993124002134/pdfft?md5=1b3554c2bd274a8e02ee0c198dc9bc5d&pid=1-s2.0-S2772993124002134-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of thoracic surgery short reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2772993124002134\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of thoracic surgery short reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772993124002134","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Optimum Timing of Tracheostomy After Cardiac Operation: Descriptive Claims Database Study
Background
Suitable tracheostomy timing after cardiac operation remains controversial; hence, this study compared the effectiveness of early and late tracheostomy after cardiac operation.
Methods
By using the nationwide administrative claims database in Japan, patients who underwent cardiac operation between April 2010 and March 2020 were identified and included in this study. In-hospital mortality, incidence of deep sternal wound infection, and ventilator-free days were analyzed and compared by dividing patients into 2 groups: an early group (patients who underwent tracheostomy 1-14 days postoperatively) and a late group (patients who underwent tracheostomy 15-30 days postoperatively). Baseline characteristics were adjusted by propensity score weighting.
Results
Of 1240 patients who underwent cardiac operation and postoperative tracheostomy, 784 were included in the main analysis cohort. As the number of days between the operation and tracheostomy increased, in-hospital mortality increased, whereas ventilator-free days decreased. The early and late groups comprised 284 and 326 patients, respectively. After adjustment of baseline characteristics, the in-hospital mortality (odds ratio, 0.65; 95% CI, 0.46-0.91; P = .01) was lower in the early group than in the late group, the incidence of deep sternal wound infection (odds ratio, 0.59; 95% CI, 0.23-1.52; P = .27) was not significantly different between the 2 groups, and the early group had more ventilator-free days compared with the late group (mean difference, 5.1; 95% CI, 3.6-6.5; P < .001).
Conclusions
Early tracheostomy may be considered in patients expected to require prolonged ventilation.