Barrera Shelby C, Sanford Evan J, Ammerman Sarah B, Ferrell Jay K, Simpson C Blake, Dominguez Laura M
Department of Otolaryngology-Head and Neck Surgery, UT Health San Antonio, San Antonio, Texas, USA.
Department of Deaf Education and Hearing Science, UT Health San Antonio, San Antonio, Texas, USA.
OTO Open. 2020 Aug 26;4(3):2473974X20953090. doi: 10.1177/2473974X20953090. eCollection 2020 Jul-Sep.
To determine the prevalence of varying classes of obesity in patients undergoing tracheostomy and the associated complication rates as compared with nonobese patients.
A retrospective chart review was performed from 2012 to 2018 on all patients who underwent open tracheostomy by the Department of Otolaryngology-Head and Neck Surgery.
All tracheostomies were performed at a single tertiary care center.
Patients were classified by body mass index (BMI) according to the World Health Organization classification system: underweight (<18.5), normal-overweight (18.5-29.9), class I (30-34.9), class II (35-39.9), and class III (>40). Charts were reviewed for patient demographic information, Charlson Comorbidity Index score, surgical indication, operative time, tracheostomy tube type, and postoperative complications.
A total of 387 patients (mean ± SD BMI, 31.3 ± 14.2) were identified per the inclusion/exclusion criteria. Of patients with BMI >30 (n=153), 34.6% were categorized as obesity class I, 29.4% as class II, and 35.9% as class III. The most common indication for tracheostomy was malignancy in nonobese patients (41.5%) and respiratory failure for obese patients (58.2%). Operative time was significantly longer in obese patients, and most of these patients required an extended-length tracheostomy tube. Patients with a BMI >40 had higher rates of multiple postoperative complications or death ( = .009). Underweight patients also had a higher rate of complication than normal-overweight patients ( = .016).
Class III and underweight patients had higher rates of postoperative complications, which should be taken into consideration during perioperative counseling.
确定接受气管切开术患者中不同类型肥胖的患病率以及与非肥胖患者相比的相关并发症发生率。
对2012年至2018年期间耳鼻咽喉头颈外科进行开放性气管切开术的所有患者进行回顾性病历审查。
所有气管切开术均在一家三级医疗中心进行。
根据世界卫生组织分类系统，患者按体重指数（BMI）分类：体重过轻（<18.5）、正常超重（18.5 - 29.9）、I类（30 - 34.9）、II类（35 - 39.9）和III类（>40）。审查病历以获取患者人口统计学信息、查尔森合并症指数评分、手术指征、手术时间、气管切开管类型和术后并发症。
根据纳入/排除标准共确定了387例患者（平均±标准差BMI，31.3±14.2）。BMI>30的患者（n = 153）中，34.6%被归类为I类肥胖，29.4%为II类，35.9%为III类。气管切开术最常见的指征在非肥胖患者中是恶性肿瘤（41.5%），在肥胖患者中是呼吸衰竭（58.2%）。肥胖患者的手术时间明显更长，并且这些患者中的大多数需要延长长度的气管切开管。BMI>40的患者术后多种并发症或死亡的发生率更高（P = 0.009）。体重过轻的患者并发症发生率也高于正常超重患者（P = 0.016）。
III类和体重过轻的患者术后并发症发生率较高，在围手术期咨询时应予以考虑。
