Obesity is a predictor of increased morbidity after tracheostomy

Mamidi, Ishwarya S.; Benito, Daniel A.; Lee, Ryan; Thakkar, Punam; Goodman, Joseph; Joshi, Arjun S.

doi:10.1016/j.amjoto.2020.102651

Cited by 9 publications

(12 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The tracheostomy-related complication rate is significantly higher for obese patients [ 26 ], especially with a body mass index ≥ 35 and especially in the intraoperative and early postoperative time periods [ 27 ]. Obesity was found to be independently associated with an increased risk of overall complications, developing acute renal failure, and having unplanned 30-day readmission following tracheostomy [ 28 ]. Obese patients have a greater likelihood of complications and an increased risk of remaining tracheostomy-dependent [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Mortality Risk Factors in Patients Admitted with the Primary Diagnosis of Tracheostomy Complications: An Analysis of 8026 Patients

Levy

Smiley

Latifi

2022

IJERPH

View full text Add to dashboard Cite

Background: Tracheostomy is a procedure commonly conducted in patients undergoing emergency admission and requires prolonged mechanical ventilation. In the present study, the aim was to determine the prevalence and risk factors of mortality among emergently admitted patients with tracheostomy complications, during the years 2005–2014. Methods: This was a retrospective cohort study. Demographics and clinical data were obtained from the National Inpatient Sample, 2005–2014, to evaluate elderly (65+ years) and non-elderly adult patients (18–64 years) with tracheostomy complications (ICD-9 code, 519) who underwent emergency admission. A multivariable logistic regression model with backward elimination was used to identify the association between predictors and in-hospital mortality. Results: A total of 4711 non-elderly and 3315 elderly patients were included. Females included 44.5% of the non-elderly patients and 47.6% of the elderly patients. In total, 181 (3.8%) non-elderly patients died, of which 48.1% were female, and 163 (4.9%) elderly patients died, of which 48.5% were female. The mean (SD) age of the non-elderly patients was 50 years and for elderly patients was 74 years. The mean age at the time of death of non-elderly patients was 53 years and for elderly patients was 75 years. The odds ratio (95% confidence interval, p-value) of some of the pertinent risk factors for mortality showed by the final regression model were older age (OR = 1.007, 95% CI: 1.001–1.013, p < 0.02), longer hospital length of stay (OR = 1.008, 95% CI: 1.001–1.016, p < 0.18), cardiac disease (OR = 3.21, 95% CI: 2.48–4.15, p < 0.001), and liver disease (OR = 2.61, 95% CI: 1.73–3.93, p < 0.001). Conclusion: Age, hospital length of stay, and several comorbidities have been shown to be significant risk factors in in-hospital mortality in patients admitted emergently with the primary diagnosis of tracheostomy complications. Each year of age increased the risk of mortality by 0.7% and each additional day in the hospital increased it by 0.8%.

show abstract

Section: Discussionmentioning

confidence: 99%

Mortality Risk Factors in Patients Admitted with the Primary Diagnosis of Tracheostomy Complications: An Analysis of 8026 Patients

Levy

Smiley

Latifi

2022

IJERPH

View full text Add to dashboard Cite

show abstract

“…This is in direct contrast to existing studies that show that obesity, measured by BMI, carries a higher risk of tracheostomy complications. 13,14 This could be due to the timeline of complications assessed in different studies. Complications such as unplanned readmissions occur further from surgery while this study specifically looked at the first 14 days of the post-operative period.…”

Section: Discussionmentioning

confidence: 99%

“…13 Obesity was found to be independently associated with an increased risk of all complications, acute kidney injury, and unplanned readmission within the first 30 days of tracheal tube placement. 14 Beyond obesity, factors that were also predictive of increased complications include number of comorbidities, neck pathology, tracheostomy placement in operating room vs inpatient unit, previous radiotherapy, and previous tracheotomy. 11 Additionally, certain demographic groups may be associated with increased mortality in tracheostomy patients.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Review of Acute Post-Tracheostomy Complications in Patients with Obstructive Pulmonary Diseases

Erickson

Katta

Sun

et al. 2022

Preprint

View full text Add to dashboard Cite

Objective Tracheostomy is performed for various indications ranging from prolonged ventilation to airway obstruction. Many factors may play a role in the incidence of complications in the immediate post-operative period including patient-related factors. The relationship between obstructive pulmonary diseases and acute post-tracheostomy complications has been incompletely studied. Chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), and asthma are some of the most common pulmonary pathologies in the United States and given the clinical utility of tracheostomies among these patients, it is important to characterize the risk of acute post-operative complications. Design A retrospective chart review identified tracheostomy patients from January 2017 through December 2018 at an academic cancer center. Medical records were reviewed for the technique used, complications, and contributing patient factors. Post-operative complications were defined as any tracheostomy-related adverse event occurring within 14 days. Patient factors examined included demographics, comorbidities, and body mass index (BMI). Results The most common indication for tracheostomy among the 321 patients that met inclusion criteria was airway obstruction or a head and neck cancer surgical procedure. Obstructive pulmonary pathology (COPD, OSA, asthma) was moderately associated with acute complications in bivariate analysis (13.4% complications, p = 0.039). Among the secondary outcomes measured, radiation was associated with early complications occurring in post-operative days 0-6 (1.1%, p = 0.029). Conclusion Obstructive pulmonary patients may have a higher risk of acute post-tracheostomy complications which is clinically significant when considering the utility of ventilation and tracheostomy in the management of acute respiratory failure secondary to these conditions.

show abstract

“…This is consistent with previous studies showing that increased BMI is correlated with more post-operative complications, especially in patients who are morbidly obese. 26,27 The most common longterm postoperative complication was airway stenosis, which did not differ between the COVID-19 and non-COVID-19 patients. Mucus plugging, though, was noted to be more frequent in COVID-19 patients.…”

Section: Complicationsmentioning

confidence: 92%

Tracheostomy Outcomes in COVID-19 Patients in a Low Resource Setting

Tang

Kim

Paik

et al. 2021

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

Objectives: COVID-19 predominately affects safety net hospitals. Tracheostomies improve outcomes and decrease length of stay for COVID-19 patients. Our objectives are to determine if (1) COVID-19 tracheostomies have similar complication and mortality rates as non-COVID-19 tracheostomies and (2) to determine the effectiveness of our tracheostomy protocol at a safety net hospital. Methods: Patients who underwent tracheostomy at Los Angeles County Hospital between August 2009 and August 2020 were included. Demographics, SARS-CoV-2 status, body mass index (BMI), Charlson Co-morbidity Index (CCI), length of intubation, complication rates, decannulation rates, and 30-day all-cause mortality versus tracheostomy related mortality rates were all collected. Results: Thirty-eight patients with COVID-19 and 130 non-COVID-19 patients underwent tracheostomies. Both groups were predominately male with similar BMI and CCI, though the COVID-19 patients were more likely to be Hispanic and intubated for a longer time ( P = .034 and P < .0001, respectively). Both groups also had similar, low intraoperative complications at 2% to 3% and comparable long-term post-operative complications. However, COVID-19 patients had more perioperative complications within 7 days of surgery ( P < .01). Specifically, they were more likely to have perioperative bleeding at their tracheostomy sites ( P = .03) and long-term post-operative mucus plugging ( P < .01). However, both groups had similar 30-day mortality rates. There were no incidences of COVID-19 transmission to healthcare workers. Conclusions: COVID-19 tracheostomies are safe for patients and healthcare workers. Careful attention should be paid to suctioning to prevent mucus plugging. Level of Evidence: 3

show abstract

Obesity is a predictor of increased morbidity after tracheostomy

Cited by 9 publications

References 34 publications

Mortality Risk Factors in Patients Admitted with the Primary Diagnosis of Tracheostomy Complications: An Analysis of 8026 Patients

Mortality Risk Factors in Patients Admitted with the Primary Diagnosis of Tracheostomy Complications: An Analysis of 8026 Patients

Retrospective Review of Acute Post-Tracheostomy Complications in Patients with Obstructive Pulmonary Diseases

Tracheostomy Outcomes in COVID-19 Patients in a Low Resource Setting

Contact Info

Product

Resources

About