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Factors Associated With Otolaryngologists Performing Tracheotomy
Shady I Soliman1, Bharat Akhanda Panuganti2, David O Francis3
1Department of Otolaryngology, University of California San Diego, La Jolla.
JAMA Otolaryngology-- Head & Neck Surgery
|October 5, 2023
Summary
Otolaryngologists are more likely to perform tracheotomies on patients with complex conditions like neck surgery history or morbid obesity. These patients often have challenging clinical characteristics requiring specialized surgical expertise.
Area of Science:
- Otolaryngology
- Surgical Procedures
- Health Services Research
Background:
- Tracheotomies are commonly performed by non-otolaryngology services.
- Factors influencing specialty choice for tracheotomy are not well-defined.
- Tracheotomy approach (open vs. percutaneous) may play a role.
Purpose of the Study:
- To identify demographic and clinical factors associated with otolaryngologist-performed tracheotomies.
- To differentiate these factors from those associated with open vs. percutaneous tracheotomy techniques.
- To understand the complexity of patients undergoing tracheotomy by different specialists.
Main Methods:
- Multicenter, retrospective cohort study.
- Inclusion of adult patients (≥18 years) with cardiopulmonary failure undergoing tracheotomy.
- Analysis of data from 8 US academic institutions (2013-2016).
Main Results:
- Otolaryngologists performed 22.3% of tracheotomies.
- Factors associated with otolaryngologist performance included Black race, neck surgery history, anticoagulation therapy, morbid obesity, and higher comorbidity scores.
- Black race was associated with a lower likelihood of open tracheotomy.
Conclusions:
- Otolaryngologists are more likely to perform tracheotomies in patients with complex conditions.
- Patients undergoing otolaryngologist-performed tracheotomies often present with more challenging clinical characteristics.
- These findings highlight the need for specialized surgical expertise in complex tracheotomy cases.
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