Otolaryngology consultation tracheostomies and complex patient population.
PURPOSE
To assess for the differences in patients undergoing tracheostomy by the otolaryngology consult service versus other specialties.


MATERIALS AND METHODS
A 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.


RESULTS
805 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).


CONCLUSIONS
More complex tracheostomies are being referred to and performed by otolaryngology at our institution. Difficult and challenging tracheostomies seem to be the "standard" for otolaryngologists.
['Alfonso|Kristan P|KP|', 'Kaufman|Michael R|MR|', 'Dressler|Emily V|EV|', 'Liu|Meng|M|', 'Aouad|Rony K|RK|']
D000328:Adult D000368:Aged D005260:Female D006801:Humans D007431:Intraoperative Complications D008297:Male D008875:Middle Aged D009767:Obesity, Morbid D010036:Otolaryngology D011183:Postoperative Complications D012017:Referral and Consultation D012189:Retrospective Studies D012307:Risk Factors D014139:Tracheostomy
Otolaryngology Awake tracheostomy Comorbidities Morbid obesity Open tracheostomy Percutaneous tracheostomy