Postoperative Complications in Obese Patients After Tracheostomy. Issue 3 (August 2020)

• Record Type: Journal Article
• Authors: Barrera, Shelby C.; Sanford, Evan J.; Ammerman, Sarah B.; Ferrell, Jay K.; Simpson, C. Blake; Dominguez, Laura M.
• Is Part Of: OTO open. Volume 4:Issue 3(2020)
• Publication Date: 2020-08
• Subjects: obese -- tracheostomy -- complications -- body mass index -- underweight; Otolaryngology -- Periodicals; Otolaryngology; Electronic journals; Periodicals; 617.51
• DOI: 10.1177/2473974X20953090
• Languages: English
• ISSNs: 2473-974X

Abstract

Objective: To determine the prevalence of varying classes of obesity in patients undergoing tracheostomy and the associated complication rates as compared with nonobese patients. Study Design: A retrospective chart review was performed from 2012 to 2018 on all patients who underwent open tracheostomy by the Department of Otolaryngology–Head and Neck Surgery. Setting: All tracheostomies were performed at a single tertiary care center. Methods: Patients were classified by body mass index (BMI) according to the World Health Organization classification system: underweight (<18.5), normal-overweight (18.5-29.9), class I (30-34.9), class II (35-39.9), and class III (>40). Charts were reviewed for patient demographic information, Charlson Comorbidity Index score, surgical indication, operative time, tracheostomy tube type, and postoperative complications. Results: A total of 387 patients (mean ± SD BMI, 31.3 ± 14.2) were identified per the inclusion/exclusion criteria. Of patients with BMI >30 (n=153), 34.6% were categorized as obesity class I, 29.4% as class II, and 35.9% as class III. The most common indication for tracheostomy was malignancy in nonobese patients (41.5%) and respiratory failure for obese patients (58.2%). Operative time was significantly longer in obese patients, and most of these patients required an extended-length tracheostomy tube. Patients with a BMI >40 had higher rates of multiple postoperative complications or death ( P = .009). Underweight patients also had a higher rate of complication than normal-overweight patients ( P = .016). Conclusion: Class III and underweight patients had higher rates of postoperative complications, which should be taken into consideration during perioperative counseling.