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

Purpose 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. Methods 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. Results 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. Conclusion 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.