Implications of tracheostomy after acute type A aortic dissection repair: Longitudinal outcomes and factors associated with patients requiring it

Objective

To analyze the factors associated with the need for tracheostomy after surgical repair of acute type A aortic dissection (ATAAD) and its implications for longitudinal outcomes.

Methods

This retrospective analysis of patients who underwent ATAAD repair from 2010 to 2020 focused on a comparison of patients who required a tracheostomy versus those who did not. Adjusted regression analysis and a classification and regression tree (CART) model were used to assess factors influencing the need for tracheostomy and its association with longitudinal survival.

Results

Fifty-two of the 552 patients in the study cohort (9.4%) required a tracheostomy, performed at a median of 12 days after ATAAD repair (interquartile range [IQR], 8-17 days). The CART analysis identified the number of reintubations and the duration of initial mechanical ventilation as key predictors of tracheostomy, with subgroups showing tracheostomy rates ranging from 7% to 100%. Nearly one-half of the patients had their tracheostomy removed successfully, with a median time to removal of 33 days (IQR, 17-67 days). Compared to nontracheostomized patients, tracheostomized patients had a higher 1-year readmission rate (44.23% vs 29.58%; P = .03), including in the intensive care unit setting (34.62% vs 16.10%; P < .001). They also had significantly lower survival rates at 1 year (77.8% vs 95.3%; P < .001), 5 years (62.1% vs 86.1%; P < .001), and 10 years (43.2% vs 73.5%; P < .001).

Conclusions

Tracheostomy is associated with significant longitudinal mortality and readmissions after ATAAD repair. The CART model highlights the relevance of reintubation for clinical decision making. Improved predictive models may enable early interventions, which could mitigate the effects of prolonged mechanical ventilation and improve resource utilization. Future research should focus on refining these models and assessing postoperative rehabilitation programs.