Predictors of clinical outcome after tracheotomy in critically ill obese patients

Authors

  • J. Kenneth Byrd MD,

    Corresponding author
    1. Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    • Send correspondence to J. Kenneth Byrd, MD, Department of Otolaryngology, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite 500, Pittsburgh, PA 15213. E-mail: byrdjk@upmc.edu

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  • Viran J. Ranasinghe BS,

    1. Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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  • Kristine E. Day MD,

    1. Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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  • Bethany J. Wolf PhD,

    1. Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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  • Eric J. Lentsch MD

    1. Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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  • Presented as an oral presentation at the Triological Society Annual Meeting at the Combined Otolaryngology Spring Meeting, Orlando, Florida, U.S.A., April 12–13, 2013.

  • This work was performed in the Department of Otolaryngology–Head and Neck Surgery (j.k.b., k.e.d., v.j.r., e.j.l.), Medical University of South Carolina, Charleston, South Carolina, and the Department of Public Health Sciences (b.j.w.), Medical University of South Carolina, Charleston, South Carolina, U.S.A.

  • Dr. Byrd is currently enrolled in a Head and Neck Oncology fellowship at the University of Pittsburgh Medical Center that was awarded the Clinical Robotics Research Grant from Intuitive Surgical, Inc. Intuitive Surgical has no direct financial relationship with any of the authors and does not censor any research performed.

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

To identify patient factors associated with outcomes in critically ill obese patients requiring tracheotomy.

Study Design

Single-institution, retrospective cohort study.

Methods

Charts were reviewed for inpatients admitted to an intensive care unit from 2007 to 2010 with International Classification of Diseases, 9th Revision codes of obesity or morbid obesity and tracheotomy. Variables collected in the dataset include subject age, ethnicity, gender, body mass index, tracheotomy type, patient outcome, chief diagnosis, and medical comorbid conditions. The primary outcomes of interest were tracheotomy type and patient outcome at the time of hospital discharge. Logistic regression models were developed for the probability of each patient outcome using univariate and multivariate models.

Results

One hundred two patients met inclusion criteria. The most common outcome was tracheostomy dependence (49%). Increased mortality was independently significantly associated with pulmonary hypertension (P = .019) and African American ethnicity (P = .045). Increased tracheostomy dependence was significantly associated with obstructive sleep apnea (P = .030). Increased decannulation was significantly associated with percutaneous tracheotomy (P = .016) and Caucasian ethnicity (P < .001).

Conclusions

Obese patients in the intensive care unit who undergo tracheotomy have a high likelihood of remaining tracheostomy dependent at the time of discharge from the hospital. The factors most commonly found to be significantly associated with poor outcomes were open tracheotomy, African American ethnicity, obstructive sleep apnea, and pulmonary hypertension.

Level of Evidence

4 Laryngoscope, 124:1118–1122, 2014

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