Predictors of clinical outcome after tracheotomy in critically ill obese patients.
OBJECTIVE
To identify patient factors associated with outcomes in critically ill obese patients requiring tracheotomy.


METHODS
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.
Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Kenneth
JK
Byrd
Viran J
VJ
Ranasinghe
Kristine E
KE
Day
Bethany J
BJ
Wolf
Eric J
EJ
Lentsch
D015992:Body Mass Index; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D012189:Retrospective Studies; D014140:Tracheotomy / Q000706:statistics & numerical data*; D016896:Treatment Outcome
Obesity; critically ill; decannulation; intensive care unit; morbid obesity; mortality; outcome; tracheotomy