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Updated: Oct 11, 2025

The Rigid Tube as an Alternative in Controlling the Problematic Airway
Published on: June 6, 2020
Tracheostomy dislodgement: Are obese patients at increased risk?
Ryan Wan1, Hannah Shin1, Courtney Docherty1
1Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.
Background:
Obesity is a risk factor for tracheostomy-related complications. We aimed to investigate whether obesity was associated with a risk of unplanned tracheostomy dislodgement or decannulation (DD).
Methods:
Retrospective review of patients undergoing tracheostomy at a single institution from 2013 to 2019 was performed. The primary outcome was unplanned DD within 42 days. Obesity was assessed by body mass index (BMI) and skin-to-trachea distance (STT) measured on computed tomographic images.
Results:
25 (12%) episodes of unplanned DD occurred in 213 patients within 42 days. BMI ≥35 kg/m2 was associated with STT ≥80 mm (p < 0.0001). On multivariate analysis, STT ≥80 mm but not BMI was an independent predictor of unplanned DD (hazard ratio = 8.34 [95% confidence interval 2.85-24.4]).
Conclusions:
STT ≥80 mm was a better predictor of unplanned DD than BMI. Assessment of STT in addition to BMI may be useful to identify patients that would benefit from extended length tracheostomy tubes.
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