Clinicodemographic Predictors of Tracheotomy Tube Size and Decannulation

Abstract

Objective: We aimed to discern clinico-demographic predictors of large (≥8) tracheostomy tube size placement, and, secondarily, to assess the effect of large tracheostomy tube size and other parameters on odds of decannulation before hospital discharge. Summary of Background Data: Factors determining choice of tracheostomy tube size are not well-characterized in the current literature, despite evidence linking large tracheostomy tube size with posttracheotomy tracheal stenosis. The effect of tracheostomy tube size on timing of decannulation is also unknown, an important consideration given reported associations between endotracheal tube size and probability of failed extubation. Methods: We collected information pertaining to patients who underwent tracheotomy at 1 of 10 U.S. health care institutions between 2010 and 2019. Tracheostomy tube size was dichotomized (≥8 and <8). Multivariable logistic regression models were fit to identify predictors of (1) large tracheostomy tube size, and (2) decannulation before hospital discharge. Results: The study included 5307 patients, including 2797 (52.7%) in the large tracheostomy cohort. Patient height (odds ratio [OR] = 1.060 per inch; 95% confidence interval [CI] 1.041–1.070) and obesity (1.37; 95% CI 1.1891.579) were associated with greater odds of large tracheostomy tube; otolaryngology performing the tracheotomy was associated with significantly lower odds of large tracheostomy tube (OR = 0.155; 95% CI 0.131–0.184). Large tracheostomy tube size (OR = 1.036; 95% CI 0.885–1.213) did not affect odds of decannulation. Conclusions: Obesity was linked with increased likelihood of large tracheostomy tube size, independent of patient height. Probability of decannulation before hospital discharge is influenced by multiple patient-centric factors, but not by size of tracheostomy tube.

Factors Associated With Otolaryngologists Performing Tracheotomy

“…Our protocols have been previously described. 5 We chose to include Common Procedural Terminology codes that met our study criteria of patients aged 18 years or older who received a trache-otomy while cross-referencing the database to confirm eligibility. We excluded tracheotomies performed with other procedures and revision cases.…”

“…In this cohort study, electronic medical records at participating sites were queried for Common Procedural Terminology codes 31600, 31601, 31603, 31605, 31610, and 31612. Our protocols have been previously described . We chose to include Common Procedural Terminology codes that met our study criteria of patients aged 18 years or older who received a tracheotomy while cross-referencing the database to confirm eligibility.…”

“…4 It has been demonstrated to be negatively associated with health through unequal access to high-quality health care and by imparting a higher burden of illness on marginalized groups. 5 Importantly, in a large systematic review, McGowan et al 6 reported that although significant intensive care unit (ICU) mortality differences exist between Black and White patients (with Black patients faring worse), these differences were eliminated when controlling for variables such as socioeconomic status, chronic comorbidities, and severity of illness on admission. The disappearance of increased mortality among Black patients after patient-covariate correction would seem to suggest that although Black patients may have an increased mortality in the ICU, the difference may relate more to changes that predate their ICU admission, instead of differences in care delivered in the ICU itself.…”