P276. Readmission Burden and Longitudinal Survival Among Patients Requiring Tracheostomy After Surgery for ATAAD
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
University of Pittsburgh
Pittsburgh, PA
United States - Contact Me
Dr Carlos E. Diaz-Castrillon is a IMG - General Surgeon, currently working as a postdoctoral research fellow in the Department of Cardiothoracic Surgery at the University of Pittsburgh.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
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.
Authors
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)
Institutions
(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
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.
Authors
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)
Institutions
(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