Tracheostomy dislodgement: Are obese patients at increased risk?

Area of Science:

• Medical research
• Surgical complications
• Patient safety

Background:

• Obesity is a known risk factor for complications following tracheostomy procedures.
• Understanding specific risk factors is crucial for preventing adverse events such as tracheostomy dislodgement or decannulation (DD).

Purpose of the Study:

• To investigate the association between obesity and the risk of unplanned tracheostomy dislodgement or decannulation (DD).
• To determine if body mass index (BMI) or skin-to-trachea distance (STT) is a better predictor of DD.

Main Methods:

• Retrospective review of patients undergoing tracheostomy between 2013 and 2019.
• Assessment of obesity using body mass index (BMI) and skin-to-trachea distance (STT) measured via computed tomographic images.
• Primary outcome measured was unplanned DD within 42 days post-procedure.

Main Results:

• 25 (12%) episodes of unplanned DD occurred in 213 patients within 42 days.
• A skin-to-trachea distance (STT) of ≥80 mm was associated with a significantly higher risk of unplanned DD (hazard ratio = 8.34).
• While BMI ≥35 kg/m² correlated with STT ≥80 mm, only STT was an independent predictor of unplanned DD on multivariate analysis.

Conclusions:

• Skin-to-trachea distance (STT) ≥80 mm is a more effective predictor of unplanned tracheostomy dislodgement or decannulation (DD) than BMI.
• Measuring STT, in addition to BMI, may help identify patients who could benefit from longer tracheostomy tubes to prevent DD.