Obese patients undergoing tracheotomy may have increased lengths of hospital stays: Study
A recent study found that obesity is one of the deciding factors for the length of hospital stay and the dependency on ventilators for individuals undergoing tracheotomy, as per the results published in the journal Laryngoscope Investigative Otolaryngology.
Obesity is a global pandemic. Insulin resistance, hypertension, cancers, and respiratory diseases are some of the comorbidities of obesity. Due to reduced baseline respiratory mechanics, obese individuals are at an increased risk of prolonged mechanical ventilation which increases the risk of ventilator‐associated pneumonia, prolonged hospital stays, and nosocomial sepsis.
Tracheotomy can be used as an alternative to endotracheal intubation due to its advantages of patient comfort, ease of secretion clearing, oral intake, oral hygiene, and better airway security. However, it is associated with decannulation issues in obese individuals. Hence, researchers conducted a study to understand the implications and outcomes of tracheotomy in the obese population, promote effective counseling of patients and family members, and encourage best clinical practices.
A retrospective review was conducted between February 2017 and March 2020 on patients over 18 who underwent tracheotomy placement. Patients were categorized based on BMI into five groups: underweight, normal weight, overweight, obese, and morbidly obese, by collecting data from the electronic medical record (EMR). Kruskal–Wallis, Chi‐square, log‐rank tests, and Cox proportional hazards regression were used for statistical analysis. Pairwise comparisons of BMI were carried out based on significant differences between groups.
Findings:
- About 391 patients were included in the study.
- There were significant differences in length of stay (p = .015) and duration of mechanical ventilation (p < .001) among the groups.
- patients of normal weight had shorter hospital stays and shorter ventilation durations than obese individuals.
- a more significant proportion of patients were ventilator‐dependent at the time of discharge with each increasing BMI category from normal weight.
- After adjusting for comorbidities, the rate of tracheotomy change was found to be 0.86 times lower for every increase in the BMI category.
- A significant difference was found among the BMI groups for time to tracheotomy collar placement according to both the log‐rank test (p < .001) and the Cox model with adjustment for the presence of heart failure (p = .011).
Thus, the study concluded that obese and morbidly obese individuals have increased lengths of hospital stays and are dependent on ventilators for a longer duration when compared to non-obese individuals. An increase in BMI increases the need for higher hospital resource utilization. This helps the treating clinicians to understand the preoperative risk and educate the family and the patient to set realistic expectations for recovery.
Further reading: Obesity is a risk factor for prolonged mechanical ventilation after tracheotomy. doi:10.1002/lio2.70038.
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