Readmission Burden and Longitudinal Survival Among Patients Requiring Tracheostomy After Surgery for ATAAD

P0276 

Abstract Submission 

Carlos Diaz-Castrillon (1), Derek Serna-Gallegos (2), Pyongsoo Yoon (3), Johannes Bonatti (4), Danny Chu (5), David Kaczorowski (6), Jianhui Zhu (2), Julie Phillippi (7), Floyd Thoma (3), Danial Ahmad (3), Ibrahim Sultan (2)

(1) University of Pittsburgh, United States, (2) University of Pittsburgh Medical Center, Pittsburgh, PA, (3) UPMC, Pittsburgh, PA, (4) UPMC Heart and Vascular Institute, Pittsburgh, PA, (5) Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, (6) University of Pittsburgh Medical Center, Venetia, PA, (7) N/A, Pittsburgh, PA

Carlos Diaz-Castrillon    -  Contact Me
University of Pittsburgh

Derek Serna-Gallegos    -  Contact Me
University of Pittsburgh Medical Center

Pyongsoo Yoon    -  Contact Me
UPMC

♦Johannes Bonatti    -  Contact Me
UPMC Heart and Vascular Institute

*Danny Chu    -  Contact Me
Veterans Affairs Pittsburgh Healthcare System

*David Kaczorowski    -  Contact Me
University of Pittsburgh Medical Center

Jianhui Zhu    -  Contact Me
University of Pittsburgh Medical Center

*Julie Phillippi    -  Contact Me
N/A

Floyd Thoma    -  Contact Me
UPMC

Danial Ahmad    -  Contact Me
UPMC

*Ibrahim Sultan    -  Contact Me
University of Pittsburgh Medical Center

Carlos Diaz-Castrillon    -  Contact Me
University of Pittsburgh

Objective

The purpose of this study was to characterize the impact of requiring a tracheostomy on readmission within 1-year and survival after surgical repair of acute type A aortic dissection.

Methods

Retrospective analysis of patients undergoing surgery for acute type A aortic dissection (ATAAD) from 2010 to 2020. Comparative analyses were performed between patients with and without postoperative tracheostomy. Resource utilization was defined by the number of readmissions during the first year after the index operation. Kaplan-Meier function and multivariable Cox regression analysis were used to evaluate longitudinal survival after discharge.

Results

552 patients underwent repair for ATAAD, with 9.4% (n=52) requiring tracheostomy. The median number of days from surgery to the need for tracheostomy was 12 days (IQR 8-17). There were no significant differences between the tracheostomy and non-tracheostomy cohorts in terms of age (63.6 vs. 61.3; p=0.23). However, patients with tracheostomy were more likely to have a higher BMI (32.1 vs 29.9; p=0.02), hypertension (88.5% vs 75.8%; p=0.03), diabetes mellitus (21.2% vs 9.6%; p=0.01), and mal perfusion syndrome (50% vs 29%; p=0.002).

The tracheostomy cohort experienced a greater rate of readmission within the first-year post-surgery (44.2% vs. 29.5%; p=0.03), with one-third of these patients needing ICU readmission (34.2% vs. 16.1%; p=0.001). While the difference in in-hospital mortality wasn't statistically significant (9.40% vs. 13.4%; p=0.34), after surviving the initial hospitalization, tracheostomy patients exhibited a lower 1-year survival rate (77.8%, 95% CI 64.6-88.6) as opposed to their non-tracheostomy counterparts (95.3%, 95% CI 93.2-97.8) (see Figure). Multivariable Cox regression analysis showed that requiring a tracheostomy after ATAAD surgery is associated with a 76% increased hazard of mortality after discharge (HR 1.76, 95% CI 1.03-3.00) (Table)

Conclusion

Requiring a tracheostomy after surgical repair of ATAAD has a significant impact on increased mortality during the first year. Moreover, the higher readmission burden in patients with tracheostomy highlights the substantial resource utilization associated with this patient population. These findings highlight the importance to optimize comprehensive postoperative protocols of care, aiming to enhance rehabilitation and manage resource utilization effectively for improved long-term survival after ATAAD surgery.

Anesthesia and Perioperative Management