*Purpose: Tracheostomies are commonly performed postoperatively in lung transplant recipients to provide ventilation for prolonged periods, and with relatively few studies detailing these patients’ outcomes and survival as compared to the general recipient population, this study seeks to determine if postoperative tracheostomy is a marker for worse clinical outcomes in lung transplant recipients.

*Methods: This is a retrospective analysis of 278 lung transplant recipients at a single center from 2013 to 2018. The original medical records as recorded by the onsite coordinator were reviewed along with records from the United Network of Organ Sharing to determine donor demographics, cause of death, and any evidence of early lung injury. Recipient demographics and clinical outcomes were extracted from hospital records.

*Results: Of the 278 patients included in this study, 42 underwent postoperative tracheostomy. Predictors of need for tracheostomy were higher lung allocation scores (p < 0.001), recipient hospitalization prior to transplant (p <0.001), and higher pre-transplant mean pulmonary artery pressures in recipients (p = 0.001). Additionally, patients who required a tracheostomy were more likely to have a delayed surgical closure of the chest (p < 0.001) and require over a liter of packed red blood cells intraoperatively (p < 0.001). In regard to short-term outcomes, they were more likely to require use of extracorporeal membrane oxygenation for greater than 48 hours (p < 0.001), spent longer time on the ventilator (p < 0.001), had longer hospital stays (p < 0.001), were more likely to require reintubation (p < 0.001), and had higher rates of atrial arrhythmias (p < 0.001). In comparison to the control group, the tracheostomy group had decreased survival rates at 1-year (p < 0.001) and 3-years (p = 0.01) but showed no significant difference at 5-years (p = 0.22). Kaplan-Meier analysis showed that recipients with postoperative tracheostomies had significantly higher mortality rates as compared to controls (p = 0.01).

*Conclusions: In this cohort of patients, need for postoperative tracheostomy was associated with more critically-ill patients as well as difficult intraoperative courses. Patients requiring tracheostomy also experienced worse short-term outcomes and decreased survival for the first 3 years after transplant. This data suggests that postoperative tracheostomy could be a predictor of worse clinical outcomes after lung transplantation.

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