肥胖是气管切开术后机械通气延长的危险因素。

IF 1.6 4区医学 Q2 OTORHINOLARYNGOLOGY Laryngoscope Investigative Otolaryngology Pub Date : 2024-12-17 DOI:10.1002/lio2.70038

Jacqueline Tucker BS, Nicole Ruszkay MD, Sara Sandifer BS, Tonya S. King PhD, Neerav Goyal MD MPH FACS, David Goldenberg MD FACS, John P. Gniady MD FACS

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摘要

目的：比较不同体重指数（BMI）亚组近期气管切开术患者的预后。方法：本回顾性图表回顾包括2017年2月至2020年3月期间接受气管切开术的18岁以上患者。根据体重指数将患者分为五组：体重不足、正常体重、超重、肥胖和病态肥胖。数据收集自电子病历（EMR）。统计分析采用Kruskal-Wallis检验、卡方检验、log-rank检验和Cox比例风险回归。如果发现组间有显著差异，则完成随后的BMI两两比较。结果：共纳入391例患者。两组患者住院时间（p = 0.015）和机械通气时间（p = 0.011）差异有统计学意义。结论：在接受气管切开术的患者中，肥胖和病态肥胖患者的住院时间增加。此外，他们对呼吸机的依赖时间更长，并且在出院时更有可能依赖呼吸机。重要的是要了解BMI如何影响气管切开术患者的住院过程，以便患者及其家属能够更好地了解情况。证据等级：三级。

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Obesity is a risk factor for prolonged mechanical ventilation after tracheotomy

Objective

To compare patient outcomes across body mass index (BMI) subgroups in the setting of recent tracheotomy.

Methods

This retrospective chart review included patients over 18 years old who underwent tracheotomy placement between February 2017 and March 2020. Patients were divided into five groups based on BMI: underweight, normal weight, overweight, obese, and morbidly obese. Data were collected from the electronic medical record (EMR). Statistical analyses were completed via Kruskal–Wallis, Chi-square, log-rank tests, and Cox proportional hazards regression. If significant differences were found between groups, then subsequent pairwise comparisons of BMI were completed.

Results

There were 391 patients included in the study. There were significant differences in length of stay (p = .015) and duration of mechanical ventilation (p < .001) among the groups. This was mainly driven by comparisons between the normal weight and obese groups, with patients of normal weight having shorter hospital stays and shorter ventilation durations. With each increasing BMI category from normal weight, a greater proportion of patients were ventilator-dependent at the time of discharge (p < .001). Interestingly, after adjustment for comorbidities, the rate of tracheotomy change was 0.86 times lower for every increase in BMI category (95% CI 0.77–0.96). There was a significant difference among the BMI groups with respect to time to tracheotomy collar placement according to both the log-rank test (p < .001) and the Cox model with adjustment for the presence of heart failure (p = .011).

Conclusions

Among patients undergoing tracheotomy, obese and morbidly obese patients have increased lengths of hospital stays. Additionally, they are dependent on ventilators for longer and are more likely to be ventilator-dependent at the time of discharge. It is important to understand how BMI impacts the hospital course for patients undergoing tracheotomy so that patients and their families can be better informed.