Obese Tracheostomy : A Challenging Path From Surgery to Decannulation
Copyright © 2019 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved..
PURPOSE: Well-defined or standardized tracheostomy decannulation guidelines are not available, and the long-term data on the outcomes in the obese are limited. The purpose of the present study was to determine the outcomes associated with tracheostomy for obese patients from surgery to decannulation. The specific aims were to measure 1) the rate of successful tracheostomy downsize; 2) the rate of successful tracheostomy decannulation; and 3) the associated pre-, intra-, and postoperative subject variables with tracheostomy downsizing and decannulation success.
PATIENTS AND METHODS: A retrospective cohort study was implemented to determine the outcomes associated with downsizing and decannulation after obese tracheostomy. The predictive value of the independent variables from the subjects' pre-, intra-, and postoperative periods were evaluated as they related to successful downsizing and decannulation. The included subjects had undergone tracheostomy from April 2016 to December 2018. The primary outcomes were successful downsizing and successful decannulation. A downsize checklist was created with the following yes/no criteria that should reasonably be met before downsizing a tracheostomy in an obese subject. The secondary analysis was the association between the checklist criteria and successful downsize and decannulation. The data were analyzed using the χ2 test, analysis of variance, t test, likelihood ratio, Kaplan-Meier analysis with Cox regression, and logistic binary regression, with statistical significance set at P < .05.
RESULTS: The study sample included 82 obese subjects (body mass index [BMI] >30 kg/m2), with a mean age of 55.7 ± 15.0 years; 56% were men. Only 62 of the subjects could be downsized (75.6%) and 39 (47.6%) could be decannulated. The general trend showed that an increased BMI resulted in an increased time to decannulation, long-term tracheostomy dependence, and less successful downsize and decannulation. For patients with a BMI of 30 kg/m2 or more, the downsize success rate was 93.5% and the decannulation success rate was 89.7%.
CONCLUSIONS: Obese patients have a greater likelihood of complications and an increased risk of remaining tracheostomy dependent. Consideration of the patient's BMI is crucial when initiating the decannulation progression.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:78 |
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| Enthalten in: |
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons - 78(2020), 4 vom: 01. Apr., Seite 631-643 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Weyh, Ashleigh [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 17.09.2020 Date Revised 17.09.2020 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.joms.2019.11.021 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM304811890 |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2019 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a PURPOSE: Well-defined or standardized tracheostomy decannulation guidelines are not available, and the long-term data on the outcomes in the obese are limited. The purpose of the present study was to determine the outcomes associated with tracheostomy for obese patients from surgery to decannulation. The specific aims were to measure 1) the rate of successful tracheostomy downsize; 2) the rate of successful tracheostomy decannulation; and 3) the associated pre-, intra-, and postoperative subject variables with tracheostomy downsizing and decannulation success | ||
| 520 | |a PATIENTS AND METHODS: A retrospective cohort study was implemented to determine the outcomes associated with downsizing and decannulation after obese tracheostomy. The predictive value of the independent variables from the subjects' pre-, intra-, and postoperative periods were evaluated as they related to successful downsizing and decannulation. The included subjects had undergone tracheostomy from April 2016 to December 2018. The primary outcomes were successful downsizing and successful decannulation. A downsize checklist was created with the following yes/no criteria that should reasonably be met before downsizing a tracheostomy in an obese subject. The secondary analysis was the association between the checklist criteria and successful downsize and decannulation. The data were analyzed using the χ2 test, analysis of variance, t test, likelihood ratio, Kaplan-Meier analysis with Cox regression, and logistic binary regression, with statistical significance set at P < .05 | ||
| 520 | |a RESULTS: The study sample included 82 obese subjects (body mass index [BMI] >30 kg/m2), with a mean age of 55.7 ± 15.0 years; 56% were men. Only 62 of the subjects could be downsized (75.6%) and 39 (47.6%) could be decannulated. The general trend showed that an increased BMI resulted in an increased time to decannulation, long-term tracheostomy dependence, and less successful downsize and decannulation. For patients with a BMI of 30 kg/m2 or more, the downsize success rate was 93.5% and the decannulation success rate was 89.7% | ||
| 520 | |a CONCLUSIONS: Obese patients have a greater likelihood of complications and an increased risk of remaining tracheostomy dependent. Consideration of the patient's BMI is crucial when initiating the decannulation progression | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Dolan, Jennifer |e verfasserin |4 aut | |
| 700 | 1 | |a Fattahi, Tirbod |e verfasserin |4 aut | |
| 700 | 1 | |a Fraker, John |e verfasserin |4 aut | |
| 700 | 1 | |a Salman, Salam O |e verfasserin |4 aut | |
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