Elevated BMI Is Not Associated With Adverse Outcomes in Open Airway Reconstruction

Open airway reconstruction is indicated for structural airway stenoses but may be associated with significant morbidity. While obesity influences perioperative outcomes in many surgical domains, its role in airway reconstruction remains unclear. This study evaluated associations between body mass index (BMI) and postoperative complications, intensive care unit (ICU) and hospital length of stay, and need for revision procedures following cricotracheal or tracheal resection.

A retrospective review of adults undergoing cricotracheal or tracheal resection between 2014 and 2025 was performed. Demographic, surgical, and postoperative data were analyzed. Associations between BMI (continuous and categorical) and postoperative outcomes-including complication rates, length of stay, reintubation, re-tracheotomy, restenosis, and death-were assessed using Poisson, Cox, negative binomial, and firth logistic regression.

Among 93 patients (mean BMI 28.8 ± 6.1 kg/m²), 70% were overweight or obese: 29 (31.2%) overweight (BMI 25-29.9), 24 (25.8%) Class I obesity (BMI 30-34.9), 6 (6.5%) Class II obesity (BMI 35-39.9), and 6 (6.5%) Class III obesity (BMI ≥ 40). Overall complication rate was 38.7%, with no significant difference across BMI categories (p = 0.99). BMI was not associated with ICU stay (IRR 1.01, p = 0.43) or total hospital stay (IRR 0.98, p = 0.12). Rates of specific complications-including hematoma, dehiscence, restenosis, and death-did not associate significantly with BMI. The only variable significantly associated with complications was resection length (p < 0.001).

BMI and obesity class were not associated with increased complications or prolonged recovery after tracheal resection. Obesity alone should not be considered a contraindication to open airway reconstruction.