Individuals diagnosed with hematologic malignancy (HM) commonly face elevated incidences of thrombocytopenia, thrombocytopathy, anemia, leukopenia, and coagulopathy. These conditions can markedly heighten the likelihood of complications arising during or after medical procedures. The present study was designed to investigate the safety profile and clinical outcomes of percutaneous dilatational tracheostomy (PDT) in critically ill patients with HM. A retrospective cohort analysis was conducted on patients with HM who received PDT between 2012 and 2023 in a tertiary academic medical facility. The main endpoint focused on the frequency of early bleeding complications occurring within 7 days. Additional endpoints included mortality directly linked to PDT, as well as death rates at 1 week, 30 days, and 1 year. All statistical evaluations relied on a propensity score-matched cohort to achieve comparable groups for analysis. Of the 1627 patients evaluated, 65 (4%) were identified as having HM. Those with HM presented with a notably elevated Charlson comorbidity index and demonstrated substantially increased prevalence of thrombocytopenia (defined as platelet count below 100,000/mcL) relative to non-HM patients (8.0 [IQR 5.0–11.3] vs. 5.0 [IQR 2.0–7.0], P < 0.001; and 49.2% vs. 5.0%, P < 0.001, respectively). After propensity score matching, the mortality rate at 1 week was markedly higher in the HM cohort (23.4% vs. 4.3%, P = 0.007). In contrast, intraoperative complications, bleeding events, and mortality at one year showed no meaningful differences across the groups. Percutaneous dilatational tracheostomy (PDT) appears to be a safe intervention for critically ill patients with HM. That said, this population experiences notably elevated mortality in the immediate postoperative period.
