The Effect of Post Operative Tracheostomy on Outcomes in Lung Transplant Patients

Abstract

<h3>Purpose</h3> Tracheostomy (trach) placement after lung transplantation (LTx) may be required in patients with prolonged ventilator dependence. However, little research exists on predictors and outcomes for recipients with post-LTx trachs. We examined baseline data and compared short and intermediate term patient outcomes with and without post-LTx trachs. <h3>Methods</h3> Baseline data, short/long term outcomes from patients s/p LTx performed between 1/1/12 and 6/31/19 who required trach during the index hospitalization were evaluated and compared with the trach-free cohort. <h3>Results</h3> Compared to trach-free patients, the trach cohort patients were younger (51.6±13.6 vs. 56.9±10.8, p=0.034) and had a higher mean lung allocation score (LAS) (66.6±22.8 vs. 55.2±20.7, p=0.014). They were more likely to be inpatient at time of LTx (54.2% vs 32.1%, p=0.035), had a bilateral LTx (60.8% vs 35.9%, p=0.001) and require extracorporeal life support (ECLS) pre- (16.7% vs. 1.9%, p=0.0005) and post-LTx (16.7% vs. 0.6%, p=0.001). Trach cohort patients had longer mechanical ventilation (p=0.0001) and hospital length of stay (HLOS) (p=0.0001). More patients in the trach cohort required acute rehab on discharge (p=0.0016). Although index in-hospital mortality of the trach cohort was higher (16.7% vs 2.5%, p=0.013), there was no difference in 1 year mortality (16.7% vs 8.3%, p=0.229) c/w trach-free cohort. There was significantly reduced long-term survival in trach patients (Fig.1) with limited follow up. <h3>Conclusion</h3> LTx recipients requiring post-op trach appear to be sicker, as evidenced by higher LAS and greater ECLS use pre-LTx. Trach cohort had longer duration of mechanical ventilation, post-op HLOS and discharge to acute rehabilitation. In our study, the need for post-LTx trach was associated with increased short term mortality. Although 1 year post-LTx mortality was similar between the groups, long term survival was worse in trach cohort with larger and longer studies needed.