Background and aim of the study: A regular post-cardiac surgery course does not require a prolonged stay in the cardiac surgery intensive care unit (ICU). However, a complicated postoperative period, can lead to prolonged ICU stay and prolonged ventilation, and may require a tracheostomy. Nonetheless, there is currently no consensus regarding the proper timing of tracheostomy. Data regarding long-term outcomes of early versus late tracheostomy are limited. This study represents the largest single-center experience with post-cardiac surgery tracheostomy. The aim of this study was to assess the timing of tracheostomy as a risk factor for mortality. Methods : This is a retrospective study of prospectively collected data. Patients were divided into three groups according to the timing of tracheostomy; early (4-10 days); intermediate (11-20 days) and late (≤21 days). The primary outcomes were early, intermediate, and long-term mortality. For statistical analysis we use multivariable Cox proportional hazards model. Results : Between 09.2004 and 08.2021, 12,782 patients underwent cardiac surgery at our institution, of whom 407 (3.18%) required postoperative tracheostomy. 147 (36.1%) had early, 195 (47.9%) intermediate and 65 (16%) late tracheostomy. The three groups were similar regarding their baseline characteristics and operative data. Early, 30-day and in-hospital mortality was similar for all groups. However, patients, who underwent early- and intermediate tracheostomy, demonstrating statistically significant lower mortality after 1- and 5-year (42.8%; 57.4%; 64.6%; and 55.8%; 68.7%; 75.4%, respectively; p<0.001). In our patient’s cohort Cox model show age [1.025 (1.014-1.036)] and time to tracheostomy [0.315 (0.159-0.757)] as significant factor for mortality. Conclusions : This study demonstrates a relationship between the timing of tracheostomy after cardiac surgery and mortality: early tracheostomy within 4-10 days of mechanical ventilation associated with better intermediate- and long-term survival. Short-term mortality does not seem to be affected by the timing of tracheostomy. Optimal timing of tracheostomy requires further evaluation.
Background: Ever since the coronavirus disease 2019 (COVID-19) has become a pandemic, worldwide efforts are being made to “flatten the curve”. Israel was amongst the first countries to impose significant restrictions. As a result, cardiac surgeons have been required to scale down their routine practice, resulting in a significant reduction in the number of cardiac surgeries. The aim of this study is to characterize the impact of COVID-19 on cardiac surgery in Israel. Methods: This is a retrospective observational study performed in two cardiac surgery departments in Israel and includes all patients who underwent cardiac surgery in March and April during the years 2019 and 2020. The patient cohort was divided into two groups based on the year of operation. Analysis of the patients’ baseline characteristics, operative data, and postoperative outcome, was performed. Results: The 2019 group (n=173), and the 2020 group (n=108) were similar regarding their baseline characteristics, previous medical history, and rates of previous revascularization interventions. However, compared to the 2019 group, patients in the 2020 group were found to be more symptomatic (NYHA class IV; 2.4% vs. 6.2%, p=0.007). While all patients underwent similar procedures, patients in the 2020 group had significantly longer procedural time (p<0.001). In-hospital mortality rate was found to be significantly higher in group 2020 (13% vs. 5.2%, p=0.037). Conclusions: While the number of patients undergoing cardiac surgery declined during the outbreak period, the rate of surgical mortality increased. One explanation for this might be delayed hospital arrival.