Kashlan Khaled N, Williams Amy M, Chang Steven S, Yaremchuk Kathleen L, Mayerhoff Ross
Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan, U.S.A.
Laryngoscope. 2019 Apr;129(4):847-851. doi: 10.1002/lary.27345. Epub 2018 Nov 22.
Mortality has been reported to be 22% to 45% in patients with a tracheostomy. To better counsel patients and families, we aimed to determine the effect of body mass index (BMI), socioeconomic status (SES), and the 17 conditions of the Charlson comorbidity index (CCI) on 30-day survival posttracheostomy.
This retrospective cohort study identified adult patients enrolled from our institution in the Global Tracheostomy Collaborative database from March 2014 to June 2015. Data collected included age, BMI, residential zip code, and comorbidities. Cox proportionate univariate and multivariate analyses were used to measure the impact of BMI, SES, and CCI variables with 30-day posttracheostomy survival. We used geocoding as a surrogate for patients' SES. We used Deyo's modification of the CCI, which utilized International Classification of Diseases, 9th Revision, codes to identify comorbidities.
Of 326 tracheostomies identified, the 30-day mortality rate was 15.6%. No significant differences were noted in BMI or in any of the SES categories between survivors and nonsurvivors. CCI was significantly higher in the 30-day mortality group. Congestive heart failure (hazard ratio [HR] = 2.39), severe liver disease (HR = 3.15), and peripheral vascular disease (HR = 2.62) were found to significantly impact 30-day survival.
Higher CCI and specifically severe liver disease, congestive heart failure, and peripheral vascular disease were associated with increased 30-day mortality posttracheostomy. No association was found between BMI or SES and 30-day survival. This study identified three comorbidities that independently affect mortality in tracheostomy patients, which should be discussed with patients and families before tracheostomy.
3 Laryngoscope, 129:847-851, 2019.
据报道，气管造口术患者的死亡率为22%至45%。为了更好地为患者及其家属提供咨询，我们旨在确定体重指数（BMI）、社会经济地位（SES）以及Charlson合并症指数（CCI）的17种情况对气管造口术后30天生存率的影响。
这项回顾性队列研究确定了2014年3月至2015年6月期间从我们机构纳入全球气管造口术协作数据库的成年患者。收集的数据包括年龄、BMI、居住邮政编码和合并症。采用Cox比例单因素和多因素分析来衡量BMI、SES和CCI变量对气管造口术后30天生存率的影响。我们使用地理编码作为患者SES的替代指标。我们使用了Deyo对CCI的修改版，该版本利用国际疾病分类第九版编码来识别合并症。
在326例已识别的气管造口术中，30天死亡率为15.6%。幸存者和非幸存者在BMI或任何SES类别方面均未发现显著差异。30天死亡组的CCI显著更高。发现充血性心力衰竭（风险比[HR]=2.39）、严重肝病（HR=3.15）和外周血管疾病（HR=2.62）对30天生存率有显著影响。
较高的CCI，特别是严重肝病、充血性心力衰竭和外周血管疾病与气管造口术后30天死亡率增加相关。未发现BMI或SES与30天生存率之间存在关联。本研究确定了三种独立影响气管造口术患者死亡率的合并症，在气管造口术前应与患者及其家属进行讨论。
3《喉镜》，129:847 - 851，201
