Otolaryngology consultation tracheostomies and complex patient population

Publication date: Available online 17 June 2017
Source:American Journal of Otolaryngology
Author(s): Kristan P. Alfonso, Michael R. Kaufman, Emily V. Dressler, Meng Liu, Rony K. Aouad
PurposeTo assess for the differences in patients undergoing tracheostomy by the otolaryngology consult service versus other specialties.Materials and methodsA series of 1035 tracheostomies performed at our institution from January 2013 through November 2015 was retrospectively reviewed. Patient-related factors that contribute to procedural difficulty were reviewed.Results805 consecutive tracheostomies were included. Otolaryngology performed 176/805 (21.8%) tracheostomies as a consulting service. Morbidly obese patients were three times as likely to be referred to otolaryngology as other services (adjusted OR: 3.23; 95% CI: 2.21–4.72). Mean BMI was 36.38kg/m² for Consults vs. 28.69kg/m² for Others and morbidly obese patients had a mean BMI of 49.84kg/m² vs. 42.68kg/m² for Consults and Others respectively (p<0.001). Patients with upper airway compromise (8.5% of Consults vs. 1.6% for Others) had 5.5 times higher odds to be performed by otolaryngology (adjusted OR: 5.46; 95% CI: 2.24–13.28). Otolaryngology performed 81.8% of awake tracheostomies (n=9/11). There were significantly higher proportions of patients with diabetes, renal, pulmonary and cardiovascular disease in the Consults groups vs. Others (p<0.05).ConclusionsMore complex tracheostomies are being referred to and performed by otolaryngology at our institution. Difficult and challenging tracheostomies seem to be the "standard" for otolaryngologists.



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