G.C. Wetmore1, E.R. Becker1, T.E. Wallen1, M.P. Smith1, M.D. Goodman1 1University Of Cincinnati, Surgery, Cincinnati, OH, USA
Introduction: The detrimental effects of obesity on outcomes among critically ill patients are well documented. Obesity has been independently associated with prolonged ventilator weaning and tracheostomy in certain patient populations. Our study aimed to determine the association between body mass index (BMI) and duration to tracheostomy decannulation at our institution.
Methods: At a single urban center, adult patients who underwent tracheostomy creation by the trauma, general surgery, or thoracic surgery services were retrospectively evaluated from 4/2018 through 1/2023 using data identified by the CPT code 31600. The chart review included demographics, BMI, Glasgow Coma Scale at the time of tracheostomy, the reason for respiratory failure, and dates of intubation, tracheostomy, decannulation, and death. Patients with incomplete data points were excluded. BMI grouping was used for statistical analysis: BMI <18.5, 18.5-24.9, 25-29.9, 30-34.9, 35-39.9, >40. Demographic comparisons and Spearman's rank correlation were used to determine independent associations between BMI groups.
Results: Four hundred ninety-five patients underwent tracheostomy over the five-year period. One hundred ninety-seven patients were excluded for incomplete data. The admitting services included trauma (45.2%), emergency general surgery (12.9%), medicine (9.9%), transplant (9.5%), neurosurgery (7.2%), surgical oncology (4.2%), neurocritical care (3.4%), and other (7.7%). In total, 213 patients underwent subsequent decannulation after tracheostomy. Of those that underwent decannulation 63% were male, the mean (SD) age was 52 (19) years, BMI was 31 (8.5) kg/m2, and duration of tracheostomy to decannulation was 51 (50) days. BMI category was not associated with the duration of tracheostomy amongst our included cohort (rho=0.07, p=0.32) (Table 1.) Of the 298 patients included, 28.5% (n=85) were not decannulated before death. Of these, the in-hospital mortality rate during the index hospitalization was 11.1%. Subjects who died with tracheostomy in place were older than those who survived to decannulation, with a median age of 62 years vs. 56 years (p=0.04). BMI did not differ between those who were decannulated and those who died with tracheostomy in place (P>0.1).
Conclusion: In this retrospective analysis of tracheostomies performed by the general and thoracic surgery groups at our institution, BMI was not independently associated with time to decannulation or inability to decannulate. In certain populations, BMI alone should not be used to estimate prolonged tracheostomy dependence.