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TRACHEOSTOMY DISLODGEMENT: ARE OBESE PATIENTS AT INCREASED LONG-TERM RISK?
R Wan, C Docherty, H Bhatti, H Shin, C Spector, B Thai, A Muller, A Martin, K Gile, A Liu, A Ong
Reading Health System

Background
Unplanned tracheostomy decannulation/dislodgement (DD) can be a life-threatening event that hasnít been studied well. Obesity has been associated with tracheostomy complications. We hypothesized that obese patients have increased long-term risk of DD.

Methods
Patients undergoing tracheostomies from 2013-19 were reviewed retrospectively. Those who died/transferred out on/before postoperative day 1 were excluded. Primary outcome was DD within 12 months of tracheostomy. Body mass index (BMI) and skin-to-trachea distance (STT), defined as the distance between the anterior tracheal wall and the skin measured at the level of the clavicular heads on computed tomography were recorded. The risk of DD was computed with Kaplan-Meier (K-M) estimations for STT, BMI and age as well as Cox proportional hazards modeling.

Results
Total of 212 patients with 220 tracheostomies were included. Sixty-six (31%) had a BMI of > 35 kg/m2, 14 (7%) had a STT of > 80 mm and extended-length tracheostomy tubes (ELTs) were used in the initial procedure in 23 (11%). BMI was associated with STT >80 mm (?35 kg/m2 vs. > 35 kg/m2, 0.7% vs 21%, p 35 kg/m2 (26% vs. 4%, p 80 mm (33% vs 4%, p 1 DD. Of 53 episodes, 22 (42%) occurred after discharge, 13 (42%) patients required reoperation and one died. Rates of DD were similar for BMI > 35 kg/m2 vs ? 35 kg/m2 (20% vs. 13%, p=0.2), but higher for STT> 80 mm vs. ? 80 mm (43% vs. 12%, p=0.007). Only 2 of 33 (6%) patients had ELTs at the time of the initial DD episode. By K-M estimations, risk of DD was not associated with age, BMI or ELT at time of procedure, but was associated with STT of > 80 mm (p80 mm was an independent predictor of DD.

Conclusion
DD occurred in 16% of patients within a year of tracheostomy, often post-discharge. STT of > 80 mm but not BMI was independently associated with DD. These patients may benefit from ELT.


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