Impact of Early Tracheostomy After Lung Transplantation: A National Analysis

Nicole Charland; Nikhil Chervu; Saad Mallick; Nguyen Le; Joanna Curry; Amulya Vadlakonda; Peyman Benharash

doi:10.1016/j.athoracsur.2024.02.013

Impact of Early Tracheostomy After Lung Transplantation: A National Analysis

Ann Thorac Surg. 2024 Feb 14:S0003-4975(24)00114-0. doi: 10.1016/j.athoracsur.2024.02.013. Online ahead of print.

Authors

Nicole Charland¹, Nikhil Chervu², Saad Mallick³, Nguyen Le¹, Joanna Curry¹, Amulya Vadlakonda¹, Peyman Benharash⁴

Affiliations

¹ Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
² Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California; Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
³ Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California.
⁴ Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, California; Division of Cardiac Surgery, University of California, Los Angeles, Los Angeles, California. Electronic address: pbenharash@mednet.ucla.edu.

PMID: 38360346
DOI: 10.1016/j.athoracsur.2024.02.013

Abstract

Background: Prolonged mechanical ventilation is common among lung transplant recipients, affecting nearly one-third of patients. Tracheostomy has been shown as a beneficial alternative to endotracheal intubation, but delays in tracheostomy tube placement persist. To date, no large-scale study has investigated the effect of tracheostomy timing on posttransplant outcomes.

Methods: All adults receiving tracheostomy after primary, isolated lung transplantation were identified in the 2016 to 2020 Nationwide Readmissions Database. Early tracheostomy was defined as placement before postoperative day 8 based on exploratory cohort analysis. Multivariable regression was used to evaluate the association of early tracheostomy with in-hospital mortality, select posttransplant complications, and resource utilization.

Results: Of an estimated 11,048 patients undergoing first-time lung transplantation, 1509 required a tracheostomy in the postoperative period, with 783 (51.9%) comprising the early cohort. After entropy balancing and risk adjustment, early tracheostomy placement was associated with reduced odds of death (adjusted odds ratio, 0.59; 95% CI, 0.36-0.97) and posttransplant infection (adjusted odds ratio, 0.54; 95% CI, 0.35-0.82). Further, tracheostomy within 1 week of transplantation was associated with decreased length of stay (β-coefficient, -16.5 days; 95% CI, -25.3 to -7.6 days) and index hospitalization costs (β-coefficient, -$97,600; 95% CI, -$153,000 to -$42,100).

Conclusions: The present study supports the safety of early tracheostomy among lung transplant recipients and highlights several potential benefits. Among appropriately selected patients, tracheostomy placement before postoperative day 8 may facilitate early discharge, lower costs, and reduced odds of posttransplant infection.