Is obesity truly a risk factor for mortality after tracheotomy?

Objectives: We sought to determine the short-term and long-term overall mortality rates in obese and non-obese patients after tracheotomy and to evaluate which factors, including the Charlson Comorbidity Index (CCI), predict mortality rates among obese patients. Methods: We performed a retrospective chart review of patients who underwent open tracheotomy in the operating room at a single hospital from 2005 to 2010. Results: Of 200 patients reviewed, 146 were non-obese and 54 were obese. The rate of mortality was higher at 30 days (p = 0.02) and at 1 year (p = 0.04) in obese patients (35.1% and 59.2%, respectively) than in non-obese patients (19.2% and 42.5%, respectively). The need for tracheotomy due to ventilator-dependent respiratory failure (VDRF) was much higher (p < 0.001) in obese patients (83.3%) than in non-obese patients (56.8%), and the rate of mortality was significantly higher (p < 0.001) in those who required tracheotomy for VDRF (32.8% at 30 days and 57% at 1 year) than in those who required tracheotomy for all other indications (4.2% at 30 days and 25% at 1 year). The mortality risk increased with higher CCI scores at both 30 days (p = 0.08) and 1 year (p = 0.009). Conclusions: The overall mortality rate is higher in obese patients after tracheotomy than in non-obese control subjects in the short and long terms. This increased rate of mortality is due to the heightened incidence of tracheotomy for VDRF among obese patients. The mortality rates after tracheotomy correlate well with the CCI.