Critically ill patients with hematologic malignancies (HM) frequently present with blood-related complications such as thrombocytopenia, coagulopathy, anemia, and leukopenia, which can considerably elevate the risk of both procedural and post-procedural adverse events. This study investigates the safety profile and clinical outcomes of percutaneous dilatational tracheostomy (PDT) in this high-risk population. We conducted a retrospective cohort study of HM patients who underwent PDT at a tertiary academic hospital from 2012 to 2023. The primary endpoint was the occurrence of bleeding complications within the first 7 days post-procedure. Secondary outcomes included procedure-related mortality and overall mortality at 7 days, thirty days, and one year. Propensity score matching was employed to adjust for baseline differences and allow accurate comparison with non-HM patients.
Among 1,627 patients included, 65 (4 percent) had HM. Patients with HM exhibited a higher Charlson comorbidity index and a markedly greater prevalence of thrombocytopenia (platelets <100,000/mcL) than patients without HM (8.0 [IQR 5.0–11.3] vs. 5.0 [IQR 2.0–7.0], p < 0.001; and 49.2 percent vs. 5.0 percent, p < 0.001, respectively). After matching, 7-day mortality was significantly elevated in the HM cohort (23.4 percent vs. 4.3 percent, p = 0.007), yet rates of intraoperative complications, early bleeding, and 1-year mortality were comparable between groups. PDT can be performed safely in critically ill HM patients; however, they remain at higher risk of early mortality following the procedure.
