Vol.:(0123456789) 1 3 General Thoracic and Cardiovascular Surgery (2018) 66:529–536 https://doi.org/10.1007/s11748-018-0949-3 ORIGINAL ARTICLE Efect of early tracheostomy on clinical outcomes in critically ill lung transplant recipients Ryo Miyoshi 1  · Toyofumi F. Chen‑Yoshikawa 1  · Masatsugu Hamaji 1  · Atsushi Kawaguchi 2  · Hidenao Kayawake 1  · Kyoko Hijiya 1  · Hideki Motoyama 1  · Akihiro Aoyama 1  · Hiroshi Date 1 Received: 10 March 2018 / Accepted: 21 May 2018 / Published online: 23 May 2018 © The Japanese Association for Thoracic Surgery 2018 Abstract Objectives The purpose of this study was to evaluate the efect of early tracheostomy in patients following lung transplanta- tion and to determine its optimal timing and infuence on clinical outcomes. Methods We retrospectively reviewed records of 96 adult patients who underwent lung transplantation at our institution between August 2008 and January 2016. Time-to-tracheostomy was defned based on timing of the procedure: “early” if less than 3 days or “late” if 3 or more days after lung transplantation. Results Forty-nine patients (51%) underwent tracheostomy 3.2 ± 1.8 days after lung transplantation. Among these patients, 21 patients (42.9%) underwent early tracheostomy and 28 patients (57.1%) underwent late tracheostomy. Multivariable logistic regression analysis indicated that preoperative performance status was a signifcant predictor for tracheostomy (p = 0.006, odds ratio 2.72). Patients in the early tracheostomy group began walking (p = 0.003) and oral feeding (p = 0.0006) earlier and had a shorter duration of mechanical ventilation (p = 0.04) and shorter length of intensive care unit (p = 0.01) and hospital stay (p = 0.04) than patients in the late tracheostomy group. No signifcant diferences in postoperative walking (p = 0.06), oral feeding (p = 0.17), or length of hospital stay (p = 0.37) were observed between patients who underwent early tracheostomy and those who did not undergo tracheostomy. Conclusions Early tracheostomy following lung transplantation decreased both intensive care and hospital stay, due to improved postoperative recovery, even in patients with poor preoperative conditions. Furthermore, length of hospital stay in patients with early tracheostomy was similar to that of patients without tracheostomy after lung transplantation. Keywords Tracheostomy · Lung transplantation · Predictor · Hospital stay Introduction Lung transplantation is an established therapeutic option for patients with various end-stage lung diseases. Despite the advances in surgical techniques, use of immunosuppressants, and improvements in perioperative care, and organ preserva- tion, patients undergoing lung transplantation often require prolonged mechanical ventilation. Prolonged translaryngeal intubation is associ- ated with an increased risk of complications, including ventilator-associated pneumonia and laryngeal injury [1]. Therefore, tracheostomy has been used to facilitate airway management and weaning in patients who require prolonged ventilatory assistance. Guide wire-assisted percutaneous tra- cheostomy techniques have been increasingly used in vari- ous patient populations, including critically ill patients [2], and surgical tracheostomy is performed only under specifc circumstances. There are potential benefts of early tracheostomy (ET) for critically ill patients. When compared with prolonged translaryngeal intubation or late tracheostomy (LT), ET can reduce the intensive care unit length of stay (LOS) and decrease duration of mechanical ventilation and hospital LOS [3–6]. However, there are little data assessing the ben- eft of ET in lung transplant patients despite the frequent use of tracheostomy after lung transplantation [7–10]. In addition, perioperative predictors for tracheostomy in this * Hiroshi Date hdate@kuhp.kyoto-u.ac.jp 1 Department of Thoracic Surgery, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan 2 Faculty of Medicine, Center for Comprehensive Community Medicine, Saga University, Saga, Japan